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Aßmann ES, Ose J, Hathaway CA, Oswald LB, Hardikar S, Himbert C, Chellam V, Lin T, Daniels B, Kirchhoff AC, Gigic B, Grossman D, Tward J, Varghese TK, Shibata D, Figueiredo JC, Toriola AT, Beck A, Scaife C, Barnes CA, Matsen C, Ma DS, Colman H, Hunt JP, Jones KB, Lee CJ, Larson M, Onega T, Akerley WL, Li CI, Grady WM, Schneider M, Dinkel A, Islam JY, Gonzalez BD, Otto AK, Penedo FJ, Siegel EM, Tworoger SS, Ulrich CM, Peoples AR. Risk factors and health behaviors associated with loneliness among cancer survivors during the COVID-19 pandemic. J Behav Med 2024; 47:405-421. [PMID: 38418709 DOI: 10.1007/s10865-023-00465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 12/27/2023] [Indexed: 03/02/2024]
Abstract
Loneliness may exacerbate poor health outcomes particularly among cancer survivors during the COVID-19 pandemic. Little is known about the risk factors of loneliness among cancer survivors. We evaluated the risk factors of loneliness in the context of COVID-19 pandemic-related prevention behaviors and lifestyle/psychosocial factors among cancer survivors. Cancer survivors (n = 1471) seen at Huntsman Cancer Institute completed a survey between August-September 2020 evaluating health behaviors, medical care, and psychosocial factors including loneliness during COVID-19 pandemic. Participants were classified into two groups: 'lonely' (sometimes, usually, or always felt lonely in past month) and 'non-lonely' (never or rarely felt lonely in past month). 33% of cancer survivors reported feeling lonely in the past month. Multivariable logistic regression showed female sex, not living with a spouse/partner, poor health status, COVID-19 pandemic-associated lifestyle factors including increased alcohol consumption and marijuana/CBD oil use, and psychosocial stressors such as disruptions in daily life, less social interaction, and higher perceived stress and financial stress were associated with feeling lonely as compared to being non-lonely (all p < 0.05). A significant proportion of participants reported loneliness, which is a serious health risk among vulnerable populations, particularly cancer survivors. Modifiable risk factors such as unhealthy lifestyle behaviors and psychosocial stress were associated with loneliness. These results highlight the need to screen for unhealthy lifestyle factors and psychosocial stressors to identify cancer survivors at increased risk of loneliness and to develop effective management strategies.
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Affiliation(s)
- Elena S Aßmann
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Cassandra A Hathaway
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sheetal Hardikar
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Anne C Kirchhoff
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Jonathan Tward
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Thomas K Varghese
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jane C Figueiredo
- Department of Medicine, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Adetunji T Toriola
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Courtney Scaife
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher A Barnes
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Cindy Matsen
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Debra S Ma
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Howard Colman
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Jason P Hunt
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kevin B Jones
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Catherine J Lee
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Tracy Onega
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Wallace L Akerley
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jessica Y Islam
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amy K Otto
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Public Health Sciences, University of Miami, Coral Gables, FL, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, USA
| | - Erin M Siegel
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Anita R Peoples
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
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2
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Farhadfar N, Rashid N, Chen K, DeVos JD, Wang T, Ballen KK, Beitinjaneh A, Bhatt VR, Hamilton BK, Hematti P, Gadalla SM, Solomon SR, El Jurdi N, Lee CJ, MacMillan ML, Rangarajan HG, Schoemans HM, Sharma A, Spellman SR, Wingard JR, Lee SJ. Racial, Ethnic and Socioeconomic Diversity and Outcomes of Patients with Graft-versus-Host Disease: A CIBMTR Analysis. Blood Adv 2024:bloodadvances.2024013074. [PMID: 38776400 DOI: 10.1182/bloodadvances.2024013074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Socioeconomic status (SES) and race/ethnicity have been associated with outcomes of allogeneic hematopoietic cell transplantation (allo-HCT). Certain aspects of GVHD management such as the need for long term care, prolonged immunosuppressive treatment, and need for close follow up for complications may exacerbate disparities. Adults (≥ 18 years) reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) who underwent a first alloHCT for acute leukemia, myelodysplastic syndrome, or myeloproliferative neoplasm between 2008 - 2018 were included. Endpoints for those developing GVHD included overall survival (OS), transplant related mortality (TRM), and disease relapse. Models were adjusted for patient and transplant related variables. A two-sided p-value < 0.01 was considered significant. Among the 14,825 allo-HCT recipients, 6,259 (42.2%) and 6,675 (45.0%) patients developed aGVHD and cGVHD, respectively. In patients with aGVHD, non-Hispanic Blacks had increased TRM (HR 1.50, 95% CI 1.24-1.83, p=0.0001) and overall mortality (HR 1.31, 1.14-1.50, p=0.0002) compared with non-Hispanic Whites, an association that disappeared when severity of aGVHD was included in the model. Lower SES was associated with increased risk of disease relapse (p=0.0016) but not OS or TRM. In patients who developed cGVHD, race and ethnicity were not associated with OS, TRM and disease relapse. However, the highest quartile of annual household income (≥ $80,000) had improved OS (HR 0.77, 0.69-0.85, p<0.0001) and reduced TRM (HR 0.86, 0.67-0.87, p<0.0001) compared with lowest quartile, adjusting for race and ethnicity. Race/ethnicity and SES are associated with outcomes after GVHD. Optimizing health care resources available to low SES patients and strategies to minimize the risk of severe GVHD in non-Hispanic Blacks may improve long-term outcomes.
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Affiliation(s)
- Nosha Farhadfar
- Sarah Cannon Transplant & Cellular Program at Methodist Hospital, United States
| | - Nahid Rashid
- City of Hope National Medical Center, United States
| | - Karen Chen
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Jakob D DeVos
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Tao Wang
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | | | - Amer Beitinjaneh
- University of Miami Health System, Miami, Florida, United States
| | - Vijaya R Bhatt
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| | | | - Peiman Hematti
- Medical College of Wisconsin, Madison, Wisconsin, United States
| | | | - Scott R Solomon
- BMT, Leukemia and Cellular Immunotherapy Programs, Northside Hospital Cancer Institute, Atlanta, Georgia, United States
| | - Najla El Jurdi
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Catherine J Lee
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | | | | | | | - Akshay Sharma
- St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Stephen R Spellman
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota, United States
| | - John R Wingard
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Stephanie J Lee
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, United States
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3
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Mercadal S, Mussetti A, Lee CJ, Arevalo C, Odstrcil SM, Peña E, Sureda A, Couriel DR. Allogeneic stem cell transplantation and CAR-T in B-cell Non-Hodgkin Lymphoma: a two-center experience and review of the literature. Ann Hematol 2024; 103:1717-1727. [PMID: 38429536 DOI: 10.1007/s00277-024-05677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still a potentially curative option for B-cell Non-Hodgkin Lymphoma (B-NHL) in the modern immunotherapy era. The objective of this study was to analyze long-term outcomes of patients with B-NHL who received allo-HSCT. We analyzed overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD) relapse-free survival (GRFS) in 53 patients undergoing allo-HSCT from two institutions. The median follow-up of the study was 72 months (range 29-115 months). The median number of lines of therapy before allo-HSCT was 3 (range 1-6) and twenty-eight patients (53%) had received a previous autologous transplant. The 3-year PFS, OS and GRFS were 55%, 63%, and 55%, respectively. One-year non-relapse mortality was 26%. Karnofsky Performance Scale < 90 was associated with worse OS in multivariable analysis. A non-comparative analysis of a cohort of 44 patients with similar characteristics who received chimeric antigen receptor T-cell therapy was done, showing a 1-year PFS and OS were 60% and 66%, respectively. Our data shows that allo-HSCT is still a useful option for treating selected patients with R/R B-NHL. Our retrospective analysis and review of the literature demonstrate that allo-HSCT can provide durable remissions in a subset of patients with R/R B-NHL.
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Affiliation(s)
- Santiago Mercadal
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA.
- Cellular Therapy and Regenerative Medicine, University of Utah, Utah, USA.
| | - Alberto Mussetti
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Catherine J Lee
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Carolina Arevalo
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Silvina M Odstrcil
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Esteban Peña
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Anna Sureda
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Daniel R Couriel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
- Cellular Therapy and Regenerative Medicine, University of Utah, Utah, USA
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4
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Rotz SJ, Hamilton BK, Wei W, Ahmed I, Winston SA, Ballard S, Bernard RJ, Carpenter P, Farhadfar N, Ferraro C, Friend BD, Gloude NJ, Hayashi RJ, Hoyle K, Jenssen K, Koo J, Lee CJ, Mariano L, Nawabit R, Ngwube A, Lalefar N, Phelan R, Perkins L, Rao A, Rayes A, Sandheinrich T, Stafford L, Tomlinson K, Whiteside S, Wiedl C, Myers K. Fertility Potential and Gonadal Function in Survivors of Reduced-Intensity Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:534.e1-534.e13. [PMID: 38342136 PMCID: PMC11056299 DOI: 10.1016/j.jtct.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
The use of reduced-intensity conditioning (RIC) regimens has increased in an effort to minimize hematopoietic stem cell transplantation (HCT) end-organ toxicity, including gonadal toxicity. We aimed to describe the incidence of fertility potential and gonadal function impairment in adolescent and young adult survivors of HCT and to identify risk factors (including conditioning intensity) for impairment. We performed a multi-institutional, international retrospective cohort study of patients age 10 to 40 years who underwent first allogeneic HCT before December 1, 2019, and who were alive, in remission, and available for follow-up at 1 to 2 years post-HCT. For females, an AMH level of ≥.5 ng/mL defined preserved fertility potential; an AMH level of ≥.03 ng/mL was considered detectable. Gonadal failure was defined for females as an elevated follicle-stimulating hormone (FSH) level >30 mIU/mL with an estradiol (E2) level <17 pg/mL or current use of hormone replacement therapy (regardless of specific indication or intent). For males, gonadal failure was defined as an FSH level >10.4 mIU/mL or current use of hormone replacement therapy. A total of 326 patients (147 females) were available for analysis from 17 programs (13 pediatric, 4 adult). At 1 to 2 years post-HCT, 114 females (77.6%) had available FSH and E2 levels and 71 (48.3%) had available AMH levels. FSH levels were reported for 125 males (69.8%). Nearly all female HCT recipients had very low levels of AMH. One of 45 (2.2%) recipients of myeloablative conditioning (MAC) and four of 26 (15.4%) recipients of reduced-intensity conditioning (RIC) (P = .06) had an AMH ≥.5 ng/m, and 8 of 45 MAC recipients (17.8%) and 12 of 26 RIC recipients (46.2%) (P = .015) had a detectable AMH level. Total body irradiation (TBI) dose and cyclophosphamide equivalent dose (CED) were not associated with detectable AMH. The incidence of female gonadal hormone failure was 55.3%. In univariate analysis, older age at HCT was associated with greater likelihood of gonadal failure (median age, 17.6 versus 13.9; P < .0001), whereas conditioning intensity (RIC versus MAC), TBI, chronic graft-versus-host disease requiring systemic therapy, and CED were not significantly associated with gonadal function. In multivariable analysis, age remained statistically significant (odds ratio [OR]. 1.11; 95% confidence interval [CI], 1.03 to 1.22) for each year increase; P = .012), Forty-four percent of the males had gonadal failure. In univariate analysis, older age (median, 16.2 years versus 14.4 years; P = .0005) and TBI dose (P = .002) were both associated with gonadal failure, whereas conditioning intensity (RIC versus MAC; P = .06) and CED (P = .07) were not statistically significant. In multivariable analysis, age (OR, 1.16; 95% CI, 1.06-1.27 for each year increase; P = .0016) and TBI ≥600 cGy (OR, 6.23; 95% CI, 2.21 to 19.15; P = .0008) remained significantly associated with gonadal failure. Our data indicate that RIC does not significantly mitigate the risk for gonadal failure in females or males. Age at HCT and (specifically in males) TBI use seem to be independent predictors of post-transplantation gonadal function and fertility status. All patients should receive pre-HCT infertility counseling and be offered appropriate fertility preservation options and be screened post-HCT for gonadal failure.
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Affiliation(s)
- Seth J Rotz
- Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio; Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wei Wei
- Quantitate Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Ibrahim Ahmed
- Division of Pediatric Hem/Onc and BMT, Children's Mercy, Kansas City, Missouri
| | - Sameeya Ahmed Winston
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | | | - Robyn J Bernard
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | | | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainsville, Florida
| | - Christina Ferraro
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian D Friend
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital; Houston, Texas
| | - Nicholas J Gloude
- MD Division of Hematology Oncology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, California
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kerry Hoyle
- Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Kari Jenssen
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jane Koo
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Catherine J Lee
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Livia Mariano
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rawan Nawabit
- Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio
| | | | - Nahal Lalefar
- Pediatric Hematology/Oncology/BMT, UCSF Benioff Children's Hospital, Oakland, California
| | - Rachel Phelan
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laynie Perkins
- Pediatric immunology and Hematopoietic stem cell transplant program, University of Utah/Primary Children's Hospital, Salt Lake City, Utah
| | | | - Ahmad Rayes
- Pediatric immunology and Hematopoietic stem cell transplant program, University of Utah/Primary Children's Hospital, Salt Lake City, Utah
| | - Taryn Sandheinrich
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren Stafford
- Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | - Stacy Whiteside
- Department of Pediatric Hematology, Oncology, & Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio
| | - Christina Wiedl
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | - Kasiani Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Salit RB, Lee SJ, Bhatt NS, Carpenter PA, Fan X, Armstrong A, Oshima MU, Connelly-Smith L, Krakow E, Lee CJ, Vo P, Mehta R, Syrjala KL. Returning to Work Following Hematopoietic Cell Transplantation: The Survivor's Perspective. Transplant Cell Ther 2024:S2666-6367(24)00301-4. [PMID: 38561139 DOI: 10.1016/j.jtct.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
While curing a patient's underlying disease is the primary goal of physicians performing hematopoietic cell transplantation (HCT), the ultimate objective is to provide patients with optimal post-HCT quality of life. For many survivors, this includes returning to work (RTW). We conducted a survey of 1- to 5-yr post-HCT survivors at our center to evaluate their perspective on facilitators and barriers to RTW as well as to gauge interest in potentially useful RTW support interventions. Survivors aged 18 to 65 yrs (n = 994) were sent an annual survey that included 36 supplementary questions about post-HCT RTW. Survey questions were selected from published national cancer survivor surveys and then modified specifically for HCT survivors. Three hundred forty-four (35%) survivors with a mean age of 53 yrs completed the survey, of whom 272 (79%) had worked prior to their diagnosis. Of those 272 patients, 145 (53%) were working currently and another 22 (8%) had attempted to go back to work following HCT but were not presently working. We found that having had an allogeneic versus autologous HCT (P = .006) was associated with a decreased likelihood of currently working, whereas frequent employer communication (>once a month) (P = .070) and having a more supportive employer (P = .036) were associated with a greater chance of currently working. Of survivors currently working, 45% reported that they had made one or more changes to their work schedule (e.g., flexible schedule or part-time work) or environment (e.g., work from home) upon RTW. Ninety-five percent of responders reported that they could have benefited from RTW support provided by the transplant center, but only 13% indicated that they had received it. Education on RTW challenges, information on disability benefits, and access to physical therapy were among the most requested support interventions. To improve post-HCT quality of life for survivors open to assistance, providers should address work status and goals, recognize barriers to successful return, and offer RTW support including working directly with employers. Allogeneic HCT survivors are particularly vulnerable to failing attempts to RTW and should be the target of retention interventions. A previously published manuscript on RTW guidance for providers of stem cell transplant patients endorsed by the American Society of Transplant and Cellular Therapy is available in Open Access and can be used as a tool to counsel and support these patients.
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Affiliation(s)
- Rachel B Salit
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington.
| | - Stephanie J Lee
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Neel S Bhatt
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Paul A Carpenter
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Xinyi Fan
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Statistics, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Ailie Armstrong
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Social Work, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Masumi Ueda Oshima
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Laura Connelly-Smith
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Elizabeth Krakow
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Catherine J Lee
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Phuong Vo
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Rohtesh Mehta
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
| | - Karen L Syrjala
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington; Division of Hematology/Oncology, University of Washington Medical Center, Seattle, Washington
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6
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Saliba RM, Lee SJ, Carpenter PA, Hill GR, Lee CJ, Alousi A, Daher M, Chen G, Champlin RE, Rezvani K, Shpall EJ, Mehta RS. Mycophenolate mofetil is associated with inferior overall survival in cytomegalovirus seropositive patients with acute myeloid leukemia undergoing hematopoietic cell transplantation. Haematologica 2024. [PMID: 38426274 DOI: 10.3324/haematol.2023.284501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 03/02/2024] Open
Abstract
Not available.
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Affiliation(s)
- Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephanie J Lee
- Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Paul A Carpenter
- Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Division of Pediatric Hematology, Oncology, Bone Marrow Transplant and Cellular Therapy, Seattle Children's Hospital, Seattle, WA
| | - Geoffrey R Hill
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Houston, TX
| | - Catherine J Lee
- Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - May Daher
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rohtesh S Mehta
- Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
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Banerjee R, Cowan AJ, Ortega M, Missimer C, Carpenter PA, Oshima MU, Salit RB, Vo PT, Lee CJ, Mehta RS, Kuderer NM, Shankaran V, Lee SJ, Su CT. Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00090-9. [PMID: 38521640 DOI: 10.1016/j.clml.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients with multiple myeloma (MM) may be on therapy for years, which can lead to financial toxicity (FinTox) or time toxicity (TimeTox). The prevalence, predictors, and quality of life (QOL) impacts of FinTox and TimeTox during different phases of MM treatment have not been characterized. PATIENTS AND METHODS We conducted a single-center cross-sectional survey of patients with MM who had undergone transplantation. FinTox+ was defined as a COST-FACIT score <23, TimeTox+ as MM-related interactions (including phone calls) ≥1x weekly or ≥1x monthly in-person among far-residing patients, QOL using PROMIS Global Health, and functional status using patient-reported Karnofsky performance status (KPS). RESULTS Of 252 patients, 22% and 40% met FinTox+ and TimeTox+ criteria respectively. Respective FinTox+ and TimeTox+ proportions were 22%/37% for patients on maintenance, 22%/82% with active therapy, and 20%/14% with observation. FinTox+ predictors included annual income (P < .01) and out-of-pocket costs (P < .01). TimeTox+ predictors included disease status (P < .001), caregiver status (P = .01), far-residing status (P < .001), and out-of-pocket costs (P = .03). FinTox+ was associated with a clinically meaningful decrease in mental QOL, while TimeTox+ patients were more likely to have KPS ≤ 80. CONCLUSIONS In our large study, monetary status but not disease status predicted FinTox. Over a third of patients on maintenance reported TimeTox. FinTox+ was associated with decreased mental health, while TimeTox+ was associated with worse performance status. These two toxicities may negatively impact patient wellbeing, and studies of strategies to mitigate their impact are in development.
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Affiliation(s)
- Rahul Banerjee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Marivel Ortega
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Masumi Ueda Oshima
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rachel B Salit
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Phuong T Vo
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Catherine J Lee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rohtesh S Mehta
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Veena Shankaran
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephanie J Lee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Christopher T Su
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
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Hashibe M, Wei M, Lee CJ, Tao R, Koric A, Wang J, Daud A, Tay D, Shen J, Lee YCA, Chang CPE. Incident Cardiovascular Disease Risk among Older Asian, Native Hawaiian and Pacific Islander Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2024; 33:126-135. [PMID: 37843411 PMCID: PMC10842246 DOI: 10.1158/1055-9965.epi-23-0679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/11/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Cardiotoxicity among breast cancer survivors is associated with chemotherapy and radiation therapy. The risk of cardiovascular disease (CVD) among Asian, Native Hawaiian and Pacific Islander (ANHPI) breast cancer survivors in the United States is unknown. METHODS We used the SEER-Medicare linked database to estimate the risk of CVD among older breast cancer survivors. International Classification of Disease diagnosis codes were used to identify incident CVD outcomes. Cox proportional hazards models were used to estimate HRs and 95% confidence intervals (CI) comparing ANHPI with Non-Hispanic White (NHW) patients with breast cancer for CVD, and among ANHPI race and ethnicity groups. RESULTS A total of 7,122 ANHPI breast cancer survivors and 21,365 NHW breast cancer survivors were identified. The risks of incident heart failure and ischemic heart disease were lower among ANHPI compared with NHW breast cancer survivors (HRheart failure, 0.72; 95% CI, 0.61-0.84; HRheart disease, 0.74; 95% CI, 0.63-0.88). Compared with Japanese patients with breast cancer, Filipino, Asian Indian and Pakistani, and Native Hawaiian breast cancer survivors had higher risks of heart failure. ischemic heart disease and death. Among ANHPI breast cancer survivors, risk factors for heart failure included older age, higher comorbidity score, distant cancer stage and chemotherapy. CONCLUSIONS Our results support heterogeneity in CVD outcomes among breast cancer survivors among ANHPI race and ethnicity groups. Further research is needed to elucidate the disparities experienced among ANHPI breast cancer survivors. IMPACT Filipino, Asian Indian and Pakistani, and Native Hawaiian patients with breast cancer had higher risks of heart failure, ischemic heart disease and death among ANHPI patients with breast cancer.
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Affiliation(s)
- Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | - Mei Wei
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Catherine J. Lee
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Hematology & Hematologic Malignancies, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Randa Tao
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alzina Koric
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jing Wang
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Anees Daud
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Jincheng Shen
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Yuan-chin A. Lee
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Chun-Pin E. Chang
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Odstrcil MS, Lee CJ, Sobieski C, Weisdorf D, Couriel D. Access to CAR T-cell therapy: Focus on diversity, equity and inclusion. Blood Rev 2024; 63:101136. [PMID: 37863793 DOI: 10.1016/j.blre.2023.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
Chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment of hematologic malignancies in patients with relapsed or refractory disease without other treatment options. However, only a very small proportion of patients with an indication for CAR T-cell can access the treatment. The imbalance between supply and demand is magnified in minority and vulnerable populations. Limited access is multifactorial and in part a result of factors directly related to the cellular product such as cost, complex logistics and manufacturing limitations. On the other hand, the impact of diversity, equity, and inclusion (DEI) and their social and structural context are also key to understanding access barriers in cellular therapy and health care in general. CAR T-cell therapy provides us with a new opportunity to better understand and prioritize this gap, a key step towards proactively and strategically addressing access. The aim of this review is to provide an analysis of the current state of access to CAR T therapy with a focus on the influence of DEI. We will cover aspects related to the cellular product and the inseparable context of social and structural determinants. Identifying and addressing barriers is necessary to ensure equitable access to this and all future novel therapies.
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Affiliation(s)
- Maria S Odstrcil
- Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA
| | - Catherine J Lee
- Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | - Catherine Sobieski
- Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA
| | - Daniel Weisdorf
- University of Minnesota Medical School, Division of Hematology, Oncology and Transplantation, Minneapolis, MN, USA
| | - Daniel Couriel
- Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA.
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10
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Lee CJ, Wang T, Chen K, Arora M, Brazauskas R, Spellman SR, Kitko C, MacMillan ML, Pidala JA, Badawy SM, Bhatt N, Bhatt VR, DeFilipp Z, Diaz MA, Farhadfar N, Gadalla S, Hashmi S, Hematti P, Hossain NM, Inamoto Y, Lekakis LJ, Sharma A, Solomon S, Lee SJ, Couriel DR. Severity of Chronic Graft-versus-Host Disease and Late Effects Following Allogeneic Hematopoietic Cell Transplantation for Adults with Hematologic Malignancy. Transplant Cell Ther 2024; 30:97.e1-97.e14. [PMID: 37844687 PMCID: PMC10842798 DOI: 10.1016/j.jtct.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/06/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
The study aimed to determine the association of chronic graft-versus-host disease (cGVHD) diagnosis and severity with the development of subsequent neoplasms (SN) and nonmalignant late effects (NM-LE) in 2-year disease-free adult survivors following hematopoietic cell transplantation (HCT) for a hematologic malignancy. To do so, we conducted a retrospective analysis of 3884 survivors of HCT for hematologic malignancy in the Center of International Blood and Marrow Transplant Research database. We conducted a landmark analysis at the 2-year post-transplantation date, comparing first SN and NM-LE in survivors with and without cGVHD. The cumulative incidence (CuI) of SN and NM-LE were estimated through 10 years post-HCT in both groups, with death or disease relapse as a competing risk. Cox proportional hazards models were used to evaluate the associations of cGVHD and its related characteristics with the development of SN and NM-LE. The estimated 10-year CuI of SN in patients with GVHD (n = 2669) and patients without cGVHD (n = 1215) was 15% (95% confidence interval [CI], 14% to 17%) versus 9% (7.2% to 11%) (P < .001). cGVHD by 2 years post-HCT was independently associated with SN (hazard ratio [HR], 1.94; 95% CI, 1.53 to 2.46; P < .0001) with a standardized incidence ratio of 3.2 (95% CI, 2.9 to 3.5; P < .0001). Increasing severity of cGVHD was associated with an increased risk of SN. The estimated 10-year CuI of first NM-LE in patients with and without cGVHD was 28 (95% CI, 26% to 30%) versus 13% (95% CI, 11% to 15%) (P < .001). cGVHD by 2 years post-HCT was independently associated with NM-LE (HR, 2.23; 95% CI, 1.81 to 2.76; P < .0001). Multivariate analysis of cGVHD-related factors showed that increasing severity of cGVHD, extensive grade, having both mucocutaneous and visceral involvement, and receiving cGVHD treatment for >12 months were associated with the greatest magnitude of risk for NM-LE. cGVHD was closely associated with both SN and NM-LE in adult survivors of HCT for hematologic malignancy. Patients identified as having more severe involvement and both mucocutaneous and visceral organ involvement may warrant enhanced monitoring and screening for SNs and NM-LEs. However, caution is warranted when interpreting these results, as patients with cGVHD may have more vigilant post-transplantation health care and surveillance for late effects.
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Affiliation(s)
- Catherine J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Tao Wang
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen Chen
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mukta Arora
- Division of Hematology, Oncology and Transplant, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Ruta Brazauskas
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Carrie Kitko
- Department of Pediatrics, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Joseph A Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sherif M Badawy
- Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Evanston, Illinois
| | - Neel Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Vijaya R Bhatt
- Section of Hematology, University of Nebraska, Omaha, Nebraska
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Miguel A Diaz
- Department of Pediatrics, Hospital Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Shahinaz Gadalla
- Clinical Genetics Branch, National Cancer Institute, Rockville, Maryland
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Peiman Hematti
- Section of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nasheed M Hossain
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvnaia
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Scott Solomon
- Northside Hospital Cancer Institute, Atlanta, Georgia
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel R Couriel
- Utah Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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11
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Cheng RK, Lee CJ. Ablating Late Cardiovascular Events in Modern Hematopoietic Cell Transplantation: Not There Yet. JACC CardioOncol 2023; 5:833-835. [PMID: 38205006 PMCID: PMC10774746 DOI: 10.1016/j.jaccao.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Catherine J. Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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12
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Epperla N, Feng L, Shah NN, Fitzgerald L, Shah H, Stephens DM, Lee CJ, Ollila T, Shouse G, Danilov AV, David KA, Torka P, Hashmi H, Hess B, Barta SK, Romancik JT, Cohen JB, Annunzio K, Kittai AS, Reneau J, Zurko J, Nizamuddin IA, Winter JN, Gordon LI, Ma S, Patel R, Nastoupil L, Ahmed S, Karmali R. Outcomes of patients with secondary central nervous system lymphoma following CAR T-cell therapy: a multicenter cohort study. J Hematol Oncol 2023; 16:111. [PMID: 37946255 PMCID: PMC10633964 DOI: 10.1186/s13045-023-01508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Chimeric antigen receptor T-cell therapy (CAR-T) has been successful in treating relapsed/refractory B-cell lymphomas. However, its role in the treatment of diseases involving the central nervous system (CNS) is not well studied. We performed a multicenter retrospective cohort study to evaluate the outcomes of patients with secondary CNS lymphoma (SCNSL) who received CAR-T. Eligibility required active CNSL at the time of apheresis. The objectives included evaluation of overall survival (OS), progression-free survival (PFS), identification of predictors of complete response (CR) post-CAR-T, and assessment of risk factors for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Sixty-one patients were included in the analysis. The overall response rate was 68% with a CR rate of 57%. In the multivariable analysis, patients who experienced any grade CRS had higher odds of achieving CR (OR = 3.9, 95% CI = 1.01-15.39, p = 0.047). The median PFS was 3.3 months (95% CI = 2.6-6.0 months) with 6- and 12-month PFS rates of 35% and 16%, respectively. The median OS was 7.6 months (95% CI = 5.0-13.5 months) with 6- and 12-month OS rates of 59% and 41%, respectively. Any grade CRS and ICANS were 70% (n = 43) and 57% (n = 34), respectively with grade ≥ 3 CRS and ICANS rates of 16% and 44%. Factors associated with increased risk of CRS and ICANS included receiving axi-cel or having leptomeningeal ± parenchymal + CNS involvement, respectively. Despite achieving high response rates, most patients experience early relapse or death following CAR-T in SCNSL. The current study provides a benchmark for future trials exploring novel therapeutic options in SCNSL.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lei Feng
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nirav N Shah
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Harsh Shah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Catherine J Lee
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Fred Hutchinson Cancer Center, University of Washington Medical Center, Seattle, WA, USA
| | - Thomas Ollila
- Lifespan Cancer Institute, Brown University, Providence, RI, USA
| | | | | | - Kevin A David
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pallawi Torka
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hamza Hashmi
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brian Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - Adam S Kittai
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - John Reneau
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - Joanna Zurko
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Imran A Nizamuddin
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jane N Winter
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Leo I Gordon
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Shuo Ma
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Romil Patel
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sairah Ahmed
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Reem Karmali
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Rodríguez-Arbolí E, Lee CJ, Caballero-Velázquez T, Martínez C, García-Calderón C, Jiménez-León MR, Bermúdez-Rodríguez MA, López-Corral L, Triguero A, Onstad L, Horwitz ME, Sarantopoulos S, Lee SJ, Pérez-Simón JA. Targeting Hedgehog Signaling with Glasdegib in Patients with Refractory Sclerotic Chronic GVHD: A Report of Two Phase I/II Trials. Clin Cancer Res 2023; 29:4057-4067. [PMID: 37698881 DOI: 10.1158/1078-0432.ccr-23-0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/08/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Sclerotic chronic GVHD (scGVHD) is characterized by progressive skin fibrosis and frequent refractoriness to available therapies. Aberrant activation of Hedgehog signaling in dermal fibroblasts has been implicated in scGVHD. Here, we report the results of two phase I/II studies (NCT03415867, GETH-TC; NCT04111497, FHD) that evaluated glasdegib, a smoothened antagonist, as a novel therapeutic agent in refractory scGVHD. PATIENTS AND METHODS Adult patients with active scGVHD after ≥1 (FHD) or ≥2 (GETH-TC) lines of therapy were enrolled. Primary endpoints were dose-limiting toxicity (DLT) and MTD in the GETH-TC trial, and safety and tolerability measures in the FHD trial. Glasdegib was administered once daily in 28-day cycles. Responses were scored per 2014 NIH cGVHD criteria. Correlative studies were performed to evaluate the role of fibroblast-independent immune mechanisms on clinical activity. RESULTS Twenty (GETH-TC) and 15 (FHD) patients were recruited. Treatment-emergent grade (G) ≥2 adverse events (AE) in the GETH-TC trial included muscle cramps (85%), alopecia (50%), and dysgeusia (35%). Two patients experienced a DLT (G3 muscle cramps), and the MTD was established at 50 mg. G3 muscle cramps were the most frequently reported AE (33%) in the FHD trial. At 12-months, the skin/joint scGVHD overall response rate was 65% (all partial responses) in the GETH-TC trial and 47% (6 partial responses, 1 complete response) in the FHD cohort. No immune correlates of response were identified. CONCLUSIONS Glasdegib demonstrated promising responses in patients with refractory scGVHD, but tolerability was limited by muscle cramping.
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Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program, Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Teresa Caballero-Velázquez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, IDIBAPS, Josep Carreras Research Institute, Hospital Clínic, Barcelona, Spain
| | - Clara García-Calderón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | - María Reyes Jiménez-León
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | | | - Lucía López-Corral
- Department of Hematology, Hospital Clínico Universitario de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Ana Triguero
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, IDIBAPS, Josep Carreras Research Institute, Hospital Clínic, Barcelona, Spain
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Duke Cancer Institute, Durham, NC
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Duke Cancer Institute, Durham, NC
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
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14
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Epperla N, Kumar A, Abutalib SA, Awan FT, Chen YB, Gopal AK, Holter-Chakrabarty J, Kekre N, Lee CJ, Lekakis L, Lin Y, Mei M, Nathan S, Nastoupil L, Oluwole O, Phillips AA, Reid E, Rezvani AR, Trotman J, Zurko J, Kharfan-Dabaja MA, Sauter CS, Perales MA, Locke FL, Carpenter PA, Hamadani M. ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Diffuse Large B Cell Lymphoma. Transplant Cell Ther 2023; 29:548-555. [PMID: 37419325 DOI: 10.1016/j.jtct.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
Autologous hematopoietic cell transplantation (auto-HCT) has long been the standard approach for patients with relapsed/refractory (R/R) chemosensitive diffuse large B cell lymphoma (DLBCL). However, the advent of chimeric antigen receptor (CAR) T cell therapy has caused a paradigm shift in the management of R/R DLBCL patients, especially with the recent approval of CD19-directed CAR-T therapy in the second-line setting in high-risk groups (primary refractory and early relapse [≤12 months]). Consensus on the contemporary role, optimal timing, and sequencing of HCT and cellular therapies in DLBCL is lacking; therefore, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines undertook this project to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 20 consensus statements with a few key statements as follows: (1) in the first-line setting, there is no role for auto-HCT consolidation for patients achieving complete remission (CR) following R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone) or similar therapy in non-double-hit/triple-hit cases (DHL/THL) and in DHL/THL cases receiving intensive induction therapies, but auto-HCT may be considered in eligible patients receiving R-CHOP or similar therapies in DHL/THL cases; (2) auto-HCT consolidation with thiotepa-based conditioning is standard of care for eligible patients with primary central nervous system lymphoma achieving CR with first-line therapy; and (3) in the primary refractory and early relapse setting, the preferred option is CAR-T therapy, whereas in late relapse (>12 months), consolidation with auto-HCT is recommended for patients achieving chemosensitivity to salvage therapy (complete or partial response), and CAR-T therapy is recommended for those not achieving remission. These clinical practice recommendations will serve as a tool to guide clinicians managing patients with newly diagnosed and R/R DLBCL.
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Affiliation(s)
| | - Ambuj Kumar
- Department of Internal Medicine, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Syed A Abutalib
- Co-Director, Hematology & BMT/Cellular Therapy, Medical Director, NMDP Apheresis Midwest Program Associate Professor, Rosalind Franklin University of Medicine and Science, City of Hope, Zion, Illinois
| | - Farrukh T Awan
- Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant & Cell Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Ajay K Gopal
- University of Washington/Fred Hutch Cancer Center, Seattle, Washington
| | | | - Natasha Kekre
- Transplantation & Cellular Therapy Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine J Lee
- Transplant and Cellular Therapy Program at Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Yi Lin
- Mayo Clinic, Rochester, Minnesota
| | | | - Sunita Nathan
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois
| | | | - Olalekan Oluwole
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Adrienne A Phillips
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Erin Reid
- Moores Cancer Center at UC San Diego Health, La Jolla, California
| | - Andrew R Rezvani
- Division of Blood & Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, California
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | | | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy, Mayo Clinic, Jacksonville, Florida
| | - Craig S Sauter
- Division of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Paul A Carpenter
- University of Washington/Fred Hutch Cancer Center, Seattle, Washington
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
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15
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Trunk AD, Patel SS, Prchal JT, Sborov DW, Zander AR, Lee CJ. Allogeneic stem cell transplant for multiple myeloma & myelofibrosis with split-dose busulfan, fludarabine & cyclophosphamide. Leuk Res Rep 2023; 20:100388. [PMID: 37701906 PMCID: PMC10493243 DOI: 10.1016/j.lrr.2023.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
Allogeneic stem cell transplant can have high morbidity and mortality in patients with myelofibrosis (MF) and multiple myeloma (MM). This phase 2 study used a novel myeloablative regimen of split-dose busulfan, fludarabine, and then post-transplant cyclophosphamide. Four patients with MF and 2 with MM were enrolled. At 1 year, non-relapse mortality was 33.3%, and overall survival was 50%. Incidence of acute and chronic GVHD was 33.3% and 16.7%, respectively. Those surviving beyond 1 year (MF = 1, MM = 2) had durable remissions with a median follow-up of 42 months. This small study demonstrates relative safety & favorable key outcomes using this novel approach.
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Affiliation(s)
- Andrew D. Trunk
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, USA
| | - Sagar S. Patel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, USA
| | - Josef T. Prchal
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, USA
| | - Douglas W. Sborov
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, USA
| | - Axel R. Zander
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, USA
| | - Catherine J. Lee
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, USA
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16
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Gandhi AP, Lee CJ. Telemedicine in Hematopoietic Cell Transplantation and Chimeric Antigen Receptor-T Cell Therapy. Cancers (Basel) 2023; 15:4108. [PMID: 37627136 PMCID: PMC10452361 DOI: 10.3390/cancers15164108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Telemedicine has played an important role in delivering healthcare for primary care, chronic disease patients, and those with solid organ malignancies. However, its application in subspecialties such as hematologic malignancies, hematopoietic cell transplantation (HCT), or chimeric antigen receptor-T cell (CAR-T) therapy is not widespread since physical examination is a vital component in delivering care. During the COVID-19 pandemic, we widely used telemedicine, since protecting our immunocompromised patients became our top priority. The employment of HCT and CAR-T therapies continues to grow for high-risk hematologic malignancies, particularly in older and frail patients who must visit specialty centers for treatment access. Generally, HCT and CAR-T therapy care is highly complex, necessitating commitment from patients, caregivers, and a multidisciplinary team at specialty academic centers. All healthcare systems adapted to the crisis and implemented rapid changes during the COVID-19 public health emergency (PHE). Telemedicine, a vital modality for delivering healthcare in underserved areas, experienced rapid expansion, regardless of the geographic region, during the COVID-19 PHE. The data emerging from practices implemented during the PHE are propelling the field of telemedicine forward, particularly for specialties with complex medical treatments such as HCT and CAR-T therapy. In this review, we examine the current data on telemedicine in HCT and cellular therapy care models for the acute and long-term care of our patients.
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Affiliation(s)
- Arpita P. Gandhi
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Catherine J. Lee
- Fred Hutch Cancer Research Center, Clinical Research Division, Seattle, WA 98109, USA
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17
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Mercadal S, Gomez CA, Lee CJ, Couriel DR. Infectious complications following CAR-t cell therapy for B cell non-Hodgkin lymphoma: a single-center experience and review of the literature. Ann Hematol 2023:10.1007/s00277-023-05131-7. [PMID: 37246975 DOI: 10.1007/s00277-023-05131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/06/2023] [Indexed: 05/30/2023]
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy targeting CD19 has significantly improved outcomes in the treatment of refractory or relapsed (R/R) B-cell non-Hodgkin lymphoma (NHL). Several risk factors including CAR-T cell-related toxicities and their treatments often lead to infectious complications (ICs); however, the pattern and timeline is not well established. We evaluated ICs in 48 patients with R/R B-cell NHL following CAR-T cell therapy at our institution. Overall, 15 patients experienced 22 infection events. Eight infections (4 bacterial, 3 viral and 1 fungal) occurred within the first 30 days and 14 infections (7 bacterial, 6 viral, 1 fungal) between days 31 to 180 following CAR-T infusion. Most infections were mild-to-moderate and fifteen infections involved the respiratory tract. Two patients developed mild-to-moderate COVID-19 infection and one patient a cytomegalovirus reactivation after CAR-T infusion. Two patients developed IFIs: one case each of fatal disseminated candidiasis and invasive pulmonary aspergillosis at day 16 and 77, respectively. Patients with more than 4 prior antitumor regimens and patient's ≥ 65 years had a higher infection rate. Infections in patients with relapsed/refractory B-cell NHL are common after CAR-T despite the use of infection prophylaxis. Age ≥ 65 years and having > 4 prior antitumor treatments were identified as risk factors for infection. Fungal infections carried significant impact in morbidity and mortality, suggesting a role for increase fungal surveillance and/or anti-mold prophylaxis following high-dose steroids and tocilizumab. Four of ten patients developed an antibody response following two doses of SARS-CoV-2 mRNA vaccine.
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Affiliation(s)
- Santiago Mercadal
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
- Bone Marrow Transplant/Cellular Therapy and Regenerative Medicine, University of Utah, 2000 Cir of Hope Dr Ste 1950, Salt Lake City, Utah, 84112, USA.
| | - Carlos A Gomez
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Catherine J Lee
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Daniel R Couriel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Bone Marrow Transplant/Cellular Therapy and Regenerative Medicine, University of Utah, 2000 Cir of Hope Dr Ste 1950, Salt Lake City, Utah, 84112, USA
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18
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Trunk AD, Radwanski K, Heber C, Taylor A, Hsieh F, Harris A, Lee CJ, Phillips JD, Couriel DR. Impact of Cryopreservation on Extracorporeal Photopheresis (ECP)-Treated Leukocyte Subsets. Transplant Cell Ther 2023:S2666-6367(23)01127-2. [PMID: 36828177 DOI: 10.1016/j.jtct.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is frequently utilized in the treatment of steroid-refractory acute and chronic graft-versus-host disease (GVHD). Although the mechanism of action is not fully understood, it has been postulated that its therapeutic effect is immunologic tolerance linked to the associated apoptosis of the treated cells. Despite significant advances in allogeneic hematopoietic stem cell transplantation (HSCT), prophylaxis and treatment of GVHD remain a challenge and major limitation associated with this therapy. Use of ECP is a valuable strategy; however, it is time, cost, resource intensive, and not readily accessible. OBJECTIVE In an effort to expand access to this therapy, we are investigating the use of cryopreserved ECP-treated cells. This will provide the ability to administer a significant proportion of the treatment at a facility closer to the patient's residence, thereby decreasing the number of visits to the primary treatment center with the goal of improving and expanding access to this therapy. Here we report the effects of cryopreservation on ECP-treated leukocytes. STUDY DESIGN Mononuclear cells were pheresed from human patients, ECP-treated, and collected for viability and apoptotic analysis. Cells were then cryopreserved at -80°C or -150°C for 1 week, 1 month, and 3 months. Following thaw, repeat viability and apoptosis studies were performed on the leukocytes. RESULTS WBC viability for freshly ECP-treated leukocytes was 84.5% ± 3.5 at 1 week, 87.3% ± 5.2 at 1 month, and 79.1% ± 1.1 at 3 months post thaw. Similar results were seen for cells frozen in cryovials. Leukocytes frozen the day after ECP treatment had 1 week and 1 month WBC viabilities of 84.0 ± 4.1 and 83.1 ± 2.1, respectively. Apoptotic potential was well preserved at 3 months, with cryopreserved ECP-treated lymphocytes being 19.2%, 44.5%, 75.5%, and 94.0% apoptotic after thaw on days 0, 1, 2, and 3 in culture, respectively. CONCLUSIONS ECP-treated leukocytes cryopreserved at -80°C or -150°C for 3 months remain viable and as capable of apoptosis as freshly treated cells. Cryopreservation of an ECP-product warrants further in vivo investigation as a strategy to facilitate access to this needed therapy.
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Affiliation(s)
- Andrew D Trunk
- Utah Blood and Marrow Transplant Program at Huntsman Cancer Institute and Primary Children's Hospital, Salt Lake City, UT, 84112
| | | | | | - Ashley Taylor
- University of Utah Cell Therapy and Regenerative Medicine Facility, Salt Lake City, UT, 84108
| | - FenFen Hsieh
- University of Utah Cell Therapy and Regenerative Medicine Facility, Salt Lake City, UT, 84108
| | - Andrew Harris
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program at Huntsman Cancer Institute and Primary Children's Hospital, Salt Lake City, UT, 84112
| | - John D Phillips
- Utah Blood and Marrow Transplant Program at Huntsman Cancer Institute and Primary Children's Hospital, Salt Lake City, UT, 84112
| | - Daniel R Couriel
- Utah Blood and Marrow Transplant Program at Huntsman Cancer Institute and Primary Children's Hospital, Salt Lake City, UT, 84112.
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19
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El-Jawahri AR, Khera N, Lee CJ, Ponce DM, Bhatt V, Galvin J, Hamilton BK. Trial in Progress: A Prospective, Observational Cohort Study of Patients at Risk for Chronic Graft-Versus-Host Disease in the United States (THRIVE). Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Muffly L, Lee CJ, Gandhi A, Varma A, Scott BL, Kwon HS, Youn M, Yanagiba C, Arulprakasam J, Le A, Shizuru JA, Pang WW, Artz AS. Subanalysis from Phase 1 Study of JSP191, an Anti-CD117 Monoclonal Antibody, in Combination with Low Dose Irradiation and Fludarabine Conditioning, Shows Durable Remissions in Older Adults with Acute Myleoid Leukemia in Complete Remission Undergoing Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00128-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Greenberg SB, Ocampo AA, Xue Z, Chang NC, Thakkar KP, Reddy SB, Lee CJ, Ketchem CJ, Redd WD, Eluri S, Reed CC, Dellon ES. Increasing Rates of Esophageal Stricture and Dilation Over 2 Decades in Eosinophilic Esophagitis. Gastro Hep Adv 2022; 2:521-523. [PMID: 37293573 PMCID: PMC10249492 DOI: 10.1016/j.gastha.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- S B Greenberg
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - A A Ocampo
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Z Xue
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - N C Chang
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - K P Thakkar
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - S B Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - C J Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - C J Ketchem
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - W D Redd
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - S Eluri
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - C C Reed
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Gastroenterology and Hepatology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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22
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Cha Y, Kim HE, Jeon SB, Park SW, Lee SH, Lee CJ. PCSK9 modulates the Wnt/beta-catenin signaling pathway in myocardial ischemia/reperfusion injury. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a protein that affects cholesterol homeostasis. Recent research has found that PCSK9 has various effects on the heart that are unrelated to LDL cholesterol regulation. The Wnt/β-catenin signaling pathway plays a crucial role during heart development, and it is re-activated in response to cardiac injury. Low-density lipoprotein receptor-related proteins 5 (LRP5) act as co-receptors of Wnt ligands and are indispensable for Wnt/β-catenin signal transduction. However, it is not fully elucidated whether other members of the LDLR-superfamily may be targets of PCSK9.
Purpose
This study aimed to determine if LRP5 is a PCSK9 target, study the association between PCSK9 and Wnt/β-catenin signaling, and elucidate its effect on myocardial infarction in patients with ischemic cardiomyopathy.
Methods
The expression of Lrp5, phospho-β-catenin, total β-catenin was evaluated by western blot analysis, and the effects of overexpressed PCSK9 were tested under normoxia, hypoxia, or hypoxia/re-oxygenation (H/R) in mouse cardiomyocytes (HL-1). The transcriptional activity of β-catenin was assessed using the TOP-Flash/FOP-Flash luciferase reporter assay. In addition, the impact on various downstream targets of the Wnt/β-catenin signaling pathway was assessed using a quantitative real-time polymerase chain reaction. To examine whether PCSK9 regulates injury of cardiomyocytes in vivo, we subjected transgenic mice with cardiac-specific overexpression of PCSK9 (PCSK9 TG) and wild-type (WT) mice to either sham surgery or ischemia/reperfusion (I/R) surgery.
Results
Under hypoxic conditions, the Wnt/β-catenin signaling pathway-related genes were downregulated in HL-1 cells, as evidenced by lower Lrp5 and active phospho-β-catenin expression levels (0.5-fold, n=3, p<0.01). After H/R, the Wnt/β-catenin-related genes were recovered (1.5-fold, p<0.01) in the control group but not in the PCSK9 overexpressed group. In the luciferase reporter assay results, PCSK9 overexpression inhibited the recovery of β-catenin transcriptional activity after H/R, in contrast to the control group. Furthermore, mRNA levels of Axin2, Cyclin D1, which are the Wnt/β-catenin signaling downstream pathway targets, were down-regulated under hypoxia and recovered after H/R but did not recover in PCSK9 overexpressed cells. In the mouse I/R model, the overall protein levels of the Wnt/β-catenin signaling-related genes were down-regulated in PCSK9 TG mice compared to WT mice after I/R injury.
Conclusions
These results indicated that the regulation of PCSK9 is closely associated with the Wnt/β-catenin signaling pathway which may play a crucial role in damaged cardiomyocytes. It suggests that the regulation of PCSK9 could be a therapeutic target in patients with ischemic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Cha
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - H E Kim
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - S B Jeon
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - S W Park
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Brain Korea 21 , Seoul , Korea (Republic of)
| | - S H Lee
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - C J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Division of Cardiology , Seoul , Korea (Republic of)
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23
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Kim SE, Chun KH, Oh J, Yu HT, Lee CJ, Kim TH, Pak HN, Lee MH, Joung B, Kang SM. Prediction of response to cardiac resynchronization therapy using cardiac magnetic resonance imaging in non-ischemic dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is a well-established therapy for symptomatic heart failure with reduced ejection fraction, but the response is different for individuals. Although many modalities have been conducted to predict CRT response, cardiac magnetic resonance (CMR) to predict CRT response has still insufficient usefulness.
Purpose
We determine whether the parameters including late gadolinium enhancement (LGE) identified in CMR could act as predictors of CRT response.
Methods
We retrospectively investigated 124 patients with non-ischemic dilated cardiomyopathy who underwent CMR before CRT implantation between Jan 2010 and July 2021 in a single center. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) >15% on echocardiography after at least 3 months after CRT implantation.
Results
Among the study population (mean age 65.7±11.2 years, mean EF 25±6.5%, 50% of female), 85 (69%) patients were defined as CRT responder. The CRT responders had more left bundle branch block (LBBB) compared with non-responders [79 (92.9%) vs. 23 (59.0%), p<0.001], but there was a no difference of QRS duration (158.7 vs 165.0ms, p=0.054) between two groups. CMR analysis showed that there were no significant differences in the left ventricular (LV) chamber volume and LV ejection fraction between CRT-responder and non-responder. However, the right ventricular (RV) chamber volume was smaller (RV end-diastolic volume index, 86.3 vs 103.5 ml/m2, p=0.039; RV end-systolic volume index, 49.3 vs 68.5 ml/m2, p=0.013) and the RV ejection fraction (RVEF) was higher (46.9 vs 37.6%, p=0.002) in CRT-responders compared with non-responders. The LGE on CMR was more shown in non-responders than in CRT-responders [33 (84.6%) vs 45 (52.9%), p<0.001]. In CMR parameters, RV dysfunction (RVEF <45%) [Odds ratio (OR), 0.21 (0.05–0.93), p=0.045] and LGE [OR, 0.21 (0.05–0.58), p=0.01] were significantly associated with poor CRT response.
Conclusions
The presence of LGE and RV dysfunction on CMR were associated with poor CRT response in patients with non-ischemic dilated cardiomyopathy. Further investigation with CMR for pre-CRT patients is needed to support these results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S E Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - K H Chun
- NHIS Ilsan Hospital, Cardiology , Goyang , Korea (Republic of)
| | - J Oh
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - C J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - S M Kang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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24
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Oh J, Yoon M, Lee SH, Lee CJ, Park S, Lee SH, Kang SM. Genetic analysis of Korean non-ischemic dilated cardiomyopathy using next generation sequencing. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-ischemic dilated cardiomyopathy (NIDCM) is a genetic disorder that causes heart failure and life-threatening arrhythmia. However, there has been no study about the up-to-date genetic analysis for NIDCM in Korean. Therefore, we performed the genetic analysis of Korean NIDCM patients (pts) using next generation sequencing (NGS).
Methods
We analyzed clinical and echocardiographic data of 203 NIDCM in a single center from July 2017 to May 2020. All pts underwent NGS analysis with customized panel including 369 genes. Genetic variants were classified as pathogenic, likely pathogenic mutations or variants of uncertain significance regarding American College of Medical Genetics guideline.
Results
A total of 203 NIDCM pts (57±15 years old, 32.0% male, LVEF 28%) had NGS analysis. Thirty-seven (18.2%) pts had pathogenic or likely pathogenic mutations. The most prevalent mutated genes were TTN (n=16, 43.2%). TNNT2 (n=6, 16.2%), MYBPC3 (n=6, 16.2%) and MYH7 (n=3, 8.1%) mutated genes were common in the following order. The patients with positive panel mutation had no significant difference in initial LVEF (27% vs. 28%, p=0.216) and prevalence of atrial fibrillation (37.8% vs. 44.6%, p=0.454) compared with patients with negative panel mutation. During the median follow-up period of 40 months, there was no significant difference in composite outcome (all-cause death, heart transplantation, LVAD, heart failure re-admission, fatal arrhythmia) (35.3% vs. 32.2%, p=0.729) or presence of improved EF (≥10 points increase from baseline LVEF, and a second measurement of LVEF >40%) (41.2% vs. 50.0%, p=0.354) between the two groups.
Conclusion
This is the first study of NGS analysis in Korean NIDCM pts. We could find disease-related pathogenic or likely pathogenic mutations in 18.2% NIDCM patients. Further prospective, large study should be warranted to elucidate the effect of genetic mutation in clinical manifestation and prognosis of NIDCM in Korean population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Oh
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
| | - M Yoon
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
| | - S H Lee
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
| | - C J Lee
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
| | - S Park
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
| | - S H Lee
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
| | - S M Kang
- Yonsei University College of Medicine, Cardiology Division , Seoul , Korea (Republic of)
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25
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Chun KH, Oh J, Lee CJ, Kang SM. In-hospital glycemic variability and all-cause mortality in patients hospitalized with acute heart failure: analysis of the KorAHF registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Glycemic variability (GV) is known to be a poor prognostic marker in various diseases including cardiovascular disease.
Purpose
We investigated the association of GV with all-cause mortality in patients with acute heart failure (HF).
Methods
The Korean Acute Heart Failure registry enrolled patients hospitalized for acute HF from 2011 to 2014. Among survivors of the index hospitalization, we analyzed those who had ≥3 blood glucose measurements before discharge. Patients were divided into two groups based on their coefficient of variation (%CV) as an indicator of GV. We investigated all-cause mortality at 6 month and 1 year after discharge.
Results
The study analyzed 2,617 patients (median age 72 years, 53% male). During the median follow-up period of 11 months, 583 (22%) patients died. Compared to alive patients, patients who died had a significantly higher diabetes prevalence (46% vs. 41%, P=0.035) and higher %CV (31.0% vs. 27.5%, P<0.001). Kaplan-Meier curve analysis revealed that a high GV (%CV >21%) was associated with lower cumulative survival to all-cause death compared with a low GV (%CV ≤21%) (log-rank P<0.001). Multivariate Cox proportional analysis showed that a high GV was associated with an increased risk of 6-month mortality (hazard ratio [HR] 2.02, 95% CI 1.58–2.59, P<0.001) and one-year mortality (HR 1.57, 95% CI 1.29–1.91, P<0.001). The risk of high GV for one-year mortality was significant in non-diabetic patients (HR 1.98, 95% CI 1.55–2.53, P<0.001), but not in diabetic patients (HR 1.24, 95% CI 0.91–1.69, P=0.176; P-for-interaction=0.030).
Conclusion
A high GV (%CV >21%) before discharge was associated with all-cause mortality within 1 year, especially in non-diabetic acute HF patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K H Chun
- Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J Oh
- Yonsei University College of Medicine, Severance Cardiovascular Hospital , Seoul , Korea (Republic of)
| | - C J Lee
- Yonsei University College of Medicine, Severance Cardiovascular Hospital , Seoul , Korea (Republic of)
| | - S M Kang
- Yonsei University College of Medicine, Severance Cardiovascular Hospital , Seoul , Korea (Republic of)
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26
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Jin U, Lee CJ, Yoon M, Ha J, Oh J, Park S, Lee SH, Kang SM. The association between frailty and physical performance in elderly patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty is known to be an important prognostic indicator in heart failure (HF). The Korean version of the frail scale for Koreans (K-FRAIL) has been developed and verified. The purpose of this study is to analyze the relationship between the K-FRAIL scale and physical performance, including muscular fitness and aerobic capacity in patients with HF.
Methods
This study included 143 HF patients aged over 65 years from a single tertiary hospital. In these subjects, muscular fitness was assessed using the handgrip test and knee extensor strength measurement, and aerobic capacity was assessed by cardiopulmonary exercise test and 6-minute walk test. Frailty status was measured using the K-FRAIL questionnaire and was classified as robust (K-FRAIL scale: 0), prefrail (1–2), and frail (3–5).
Results
Mean age of participants with robust (N=37), prefrail (N=75), and frail (N=31) were 72.5, 73.5, and 76.3 years, respectively. There was no difference in sex and left ventricular ejection fraction (LVEF) among groups, but the estimated glomerular filtration rate (eGFR) was significantly lower as frailty status increased (75.6±17.2 vs. 70.0±20.5 vs. 56.1±23.7 mL/min/1.73 m2; P<0.001). Hand-grip strength and knee extensor muscle strength did not differ among groups. However, peak oxygen consumption (peak VO2; 22.8±5.0 vs. 19.3±4.6 vs. 16.9±4.7 mL/kg/min, P<0.001) and 6-min walk distance (458.4±68.2 vs. 404.5±92.3 vs. 311.2±120.5 m; p<0.001) significantly decreased according to frailty severity. In multivariate regression analysis adjusted for age, sex, haemoglobin, eGFR and LVEF, peak VO2 (β=−0.311; P=0.002) and 6-min walk distance (β=−0.384; P<0.001) showed a significant inverse association with the K-FRAIL scale. With the cut-off value from receiver-operating characteristic curve analysis, peak VO2 (hazard ratio, 5.08; p=0.023) and 6MWT (hazard ratio, 3.99; p=0.020) were independent predictor of frailty according to K-FRAIL scale.
Conclusion
In elderly HF patients, physical performance differs according to frailty status, peak VO2 and 6-min walk distance correlates with the K-FRAIL scale better than muscular fitness.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- U Jin
- Ajou University School of Medicine, Department of Cardiology , Suwon , Korea (Republic of)
| | - C J Lee
- Yonsei University College of Medicine, Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute , Seoul , Korea (Republic of)
| | - M Yoon
- Seoul National University Bundang Hospital, Department of Cardiology , Seongnam , Korea (Republic of)
| | - J Ha
- Yonsei University College of Medicine, Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute , Seoul , Korea (Republic of)
| | - J Oh
- Yonsei University College of Medicine, Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute , Seoul , Korea (Republic of)
| | - S Park
- Yonsei University College of Medicine, Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute , Seoul , Korea (Republic of)
| | - S H Lee
- Yonsei University College of Medicine, Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute , Seoul , Korea (Republic of)
| | - S M Kang
- Yonsei University College of Medicine, Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute , Seoul , Korea (Republic of)
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27
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Lee SH, Lee CJ, Park S, Han K. Dementia in individuals with severe hypercholesterolemia: Korean nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Dementia risk and benefit of lipid lowering in individuals with severe hypercholesterolemia has not been well studied. The aim of this study was to evaluate the risk of dementia and effect of lipid lowering in this population using nationwide cohort.
Methods
This study was performed using the National Health Insurance Service database of Korea. Among individuals who took health check-up and were followed-up, 1,584,401 were enrolled and analyzed. Study population were categorized to three groups with severe hypercholesterolemia according to LDL-C levels, >260, 225–259, and 190–224 mg/dL groups, and a control group (<160 mg/dL). Risks of incident dementia (all dementia, Alzheimer's disease, and vascular dementia) were compared. In the subgroup with new statin users, the effect of statins was further analyzed according to post-treatment LDL-C levels (<70, 70–99, 100–129, >130 mg/dL).
Results
In the median follow-up of 6.1 years, all dementia occurred up to 5.41/1000 person-year in the groups with severe hypercholesterolemia. Adjusted hazard ratios (aHRs) of all dementia in the groups ranged from 1.05 to 1.34 (p=0.023) and were dependent of LDL-C categories. Alzheimer's disease developed up to 4.94/1000 person-year and aHRs ranged from 1.04 to 1.38 (p=0.040) with the same pattern to all dementia. Vascular dementia occurred up to 0.59/100 person-year and aHRs ranged from 1.03 to 1.57 without significant difference according to LDL-C categories. In the median follow-up of 6.2 years in new statin users, aHRs were 0.69 to 0.92 for all dementia and 0.74 to 0.92 for Alzheimer's disease, and 0.53 to 1.15 for vascular dementia according to post-treatment LDL-C levels. However, the risk was not significantly related to the levels.
Conclusions
This study newly showed elevated risk of dementia, particularly Alzheimer's disease, in patients with severe hypercholesterolemia. The benefit of active lipid lowering on this neurological disease needs to be proven by further studies.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Korean Society of Lipid and Atherosclerosis; National Research Foundation of Korea
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Affiliation(s)
- S H Lee
- Yonsei University College of Medicine, Cardiology, Internal Medicine , Seoul , Korea (Republic of)
| | - C J Lee
- Yonsei University College of Medicine, Cardiology, Internal Medicine , Seoul , Korea (Republic of)
| | - S Park
- The Catholic University of Korea , Seoul , Korea (Republic of)
| | - K Han
- Soongsil University , Seoul , Korea (Republic of)
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28
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Pareek M, Kragholm KH, Vaduganathan M, Pallisgaard JL, Byrne C, Kristensen AMD, Biering-Sorensen T, Lee CJ, Bonde AN, Maeng M, Fosbol EL, Kober L, Gislason GH, Bhatt DL, Torp-Pedersen C. Serial high-sensitivity troponin T concentrations and long-term outcomes in patients with suspected acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
High-sensitivity troponin assays allow for accurate and rapid rule-in or rule-out of myocardial infarction (MI) among patients with acute-onset chest pain. However, prognostic implications of serial high-sensitivity troponin concentrations are unknown.
Purpose
To determine short- and long-term prognostic implications of high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome.
Methods
Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged these individuals with all records of two serial hsTnT measurements obtained ≤7 hours apart during the same hospitalization. The primary outcome was death at days 0–30 and 31–365. Prognostic implications of serial hsTnT were examined in accordance with the 2012 ESC algorithm stratifying patients for normal baseline concentrations and relative changes of 20% and 50% from baseline. In case of a normal baseline concentration, 20% and 50% of the upper reference level (14 ng/l) were used as thresholds instead, i.e., 3 ng/l and 7 ng/l, respectively. Absolute risks were calculated through multivariable logistic regression with average treatment effect modeling (G-formula).
Results
Complete data were available in 28,902 individuals (median age [25th-75th percentile] 65.2 [53.4–75.4] years, 11,632 [40.2%] women). Of these, 11,116 (38.5%) had a final diagnosis of MI, 1518 (5.3%) of unstable angina, and 16,268 (56.3%) of either suspected MI or chest pain. Median baseline hsTnT was 18 ng/l (25th-75th percentile, 10–69), second hsTnT 21 ng/l (25th-75th percentile, 10–248), relative hsTnT change 3.6% (25th-75th percentile, 0–66.7), and time between samples 4.0 hours (25th-75th percentile, 3.2–5.4). Most patients had either two normal hsTnT concentrations (9483, 32.8%) or two elevated hsTnT concentrations (18,235, 63.1%). At 30 days, 796 (2.8%) individuals had died, while an additional 1287 (4.6% of 30-day survivors) died between days 31–365. Baseline hsTnT and the relative hsTnT change both displayed a significant, non-linear association with death and interacted with each other (P<0.001). Tables 1 and 2 show the standardized, absolute risks of death (with 95% confidence intervals) from days 0–30 and from days 31–365, respectively. Patients with two normal hsTnT concentrations had very low mortality rates, irrespective of the magnitude of relative change. Conversely, patients with two elevated hsTnT concentrations consistently had high mortality rates.
Conclusions
This is the first study to assess both short- and long-term outcomes as a function of both baseline hsTnT and its change from first to second measurement. In general, patients with two normal hsTnT concentrations have an excellent prognosis while those with two elevated concentrations require scrutiny.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Pareek
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | | | - M Vaduganathan
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | | | - C Byrne
- Gentofte University Hospital , Gentofte , Denmark
| | | | | | - C J Lee
- Aalborg University Hospital , Aalborg , Denmark
| | - A N Bonde
- Gentofte University Hospital , Gentofte , Denmark
| | - M Maeng
- Aarhus University Hospital , Aarhus , Denmark
| | - E L Fosbol
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - G H Gislason
- Gentofte University Hospital , Gentofte , Denmark
| | - D L Bhatt
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
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29
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Chun KH, Oh J, Lee CJ, Kang SM. Impact of metformin on the all-cause mortality in diabetic patients hospitalized with acute heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Although the hypothesis that metformin is beneficial for diabetic patients with heart failure (HF) has been steadily raised, there have been no solid data on the efficacy of metformin in acute HF patients.
Purpose
We investigated the impact of metformin on all-cause mortality in hospitalized acute HF patients with type 2 diabetes.
Methods
The Korean Acute Heart Failure registry enrolled patients hospitalized for acute HF from 2011 to 2014. Among this cohort, we analyzed patients with diabetes. We investigated all-cause mortality at 1 year after discharge. Propensity score matching (1:1 matching) and Cox proportional hazard models were used to assess difference in all-cause mortality.
Results
The study analyzed 1,976 diabetic patients (median age 72 years, mean left ventricular ejection fraction (LVEF) 34%, 54.5% male). Among them, 712 (36%) patients were on metformin. After 1:1 propensity score matching, 1,424 patients (712 metformin users vs. 712 non-users) were analyzed. During the median follow-up period of 11 months, 146 (21%) metformin non-users died and 108 (15%) metformin users died. Kaplan-Meier curves showed a higher all-cause mortality rate in non-users than in metformin users (Log-rank P=0.0025). After adjustment for clinically relevant variables, metformin was associated with lower risk for all-cause mortality (HR 0.713, 95% CI 0.551–0.922, P=0.01). In subgroup analyses, metformin use was significantly associated with a lower all-cause mortality in higher eGFR group (≥60 ml/min/1.73 m2, HR 0.531, 95% CI 0.357–0.790, P=0.002), but not in lower eGFR group (<60 ml/min/1.73 m2, HR 0.905, 95% CI 0.643–1.275, P=0.569, P-for-interaction=0.033). There was no significant interaction of metformin use for all-cause mortality between the subgroups with LVEF ≤40% and LVEF >40% (P-for-interaction=0.906).
Conclusion
Metformin use was associated with a lower risk for 1-year all-cause mortality in diabetic acute HF patients, especially in high eGFR group.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K H Chun
- Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J Oh
- Yonsei University College of Medicine, Severance Cardiovascular Hospital , Seoul , Korea (Republic of)
| | - C J Lee
- Yonsei University College of Medicine, Severance Cardiovascular Hospital , Seoul , Korea (Republic of)
| | - S M Kang
- Yonsei University College of Medicine, Severance Cardiovascular Hospital , Seoul , Korea (Republic of)
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30
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Lee CJ, Wang T, Chen K, Arora M, Brazauskas R, Spellman SR, Kitko C, MacMillan ML, Pidala JA, Auletta JJ, Badawy SM, Bhatt N, Bhatt VR, Cahn JY, DeFilipp Z, Diaz MA, Farhadfar N, Gadalla S, Gale RP, Hashem H, Hashmi S, Hematti P, Hong S, Hossain NM, Inamoto Y, Lekakis LJ, Modi D, Patel S, Sharma A, Solomon S, Couriel DR. Association of Chronic Graft-versus-Host Disease with Late Effects following Allogeneic Hematopoietic Cell Transplantation for Children with Hematologic Malignancy. Transplant Cell Ther 2022; 28:712.e1-712.e8. [PMID: 35863740 PMCID: PMC9547959 DOI: 10.1016/j.jtct.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/15/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) occurs in up to 25% of children following allogeneic hematopoietic cell transplantation (HCT) and continues to be a major cause of late morbidity and poor quality of life among long-term survivors of pediatric HCT. Late effects (LEs) of HCT are well documented in this population, and cGVHD has been identified as a risk factor for subsequent neoplasms (SNs) and several nonmalignant LEs (NM-LEs); however, the reported correlation between cGVHD and LEs varies among studies. We compared LEs occurring ≥2 years following childhood HCT for a hematologic malignancy in 2-year disease-free survivors with and without cGVHD and further evaluated the association of cGVHD features on the development of LEs. This systematic retrospective analysis used data from the Center of International Blood and Marrow Transplant Research (CIBMTR) on a large, representative cohort of 1260 survivors of pediatric HCT for hematologic malignancy to compare first malignant LEs and NM-LEs in those with a diagnosis of cGVHD and those who never developed cGVHD. The cumulative incidences of any first LE, SN, and NM-LE were estimated at 10 years after HCT, with death as a competing risk for patients with cGVHD versus no cGVHD. Cox proportional hazards models were used to evaluate the impact of cGVHD and its related characteristics on the development of first LEs. The estimated 10-year cumulative incidence of any LE in patients with and without cGVHD was 43% (95% CI, 38% to 48.2%) versus 32% (95% confidence interval [CI], 28.5% to 36.3%) (P < .001), respectively. The development of cGVHD by 2 years post-HCT was independently associated with any LE (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.68; P = .001) and NM-LE (HR, 1.37; 95% CI, 1.10 to 1.70; P = .006), but not SN (HR, 1.30; 95% CI, .73 to 2.31; P = .38). cGVHD-related factors linked with the development of an NM-LE included having extensive grade cGVHD (HR, 1.60; 95% CI, 1.23 to 2.08; P = .0005), severe cGVHD (HR, 2.25; 95% CI, 1.60 to 3.17; P < .0001), interrupted onset type (HR, 1.57; 95% CI, 1.21 to 2.05; P = .0008), and both mucocutaneous and visceral organ involvement (HR, 1.59; 95% CI, 1.24 to 2.03; P = .0002). No significant association between cGVHD-specific variables and SN was identified. Finally, the duration of cGVHD treatment of cGVHD with systemic immunosuppression was not significantly associated with SNs or NM-LEs. cGVHD was more closely associated with NM-LEs than with SNs among survivors of pediatric HCT for hematologic malignancy. In this analysis, the development of SNs was strongly associated with the use of myeloablative total body irradiation. cGVHD-related characteristics consistent with a state of greater immune dysregulation were more closely linked to NM-LEs.
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Affiliation(s)
- Catherine J Lee
- The University of Utah Transplant and Cellular Therapy Program, Salt Lake City, Utah.
| | - Tao Wang
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen Chen
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mukta Arora
- Division of Hematology, Oncology and Transplant, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Ruta Brazauskas
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Carrie Kitko
- Department of Pediatrics, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Joseph A Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffery J Auletta
- Department of Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Sherif M Badawy
- Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Evanston, Illinois
| | - Neel Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Vijaya R Bhatt
- Section of Hematology, University of Nebraska, Omaha, Nebraska
| | - Jean-Yves Cahn
- Department of Hematology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Shahinaz Gadalla
- Clinical Genetics Branch, National Cancer Institute, Rockville, Maryland
| | - Robert P Gale
- Haematology Section, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Hasan Hashem
- Department of Pediatrics, Pediatric Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Minnesota; Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Peiman Hematti
- Section of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Sanghee Hong
- Department of Hematology and Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Nasheed M Hossain
- Loyola University Chicago-Stritch School of Medicine, Maywood, Illinois
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Dipenkumar Modi
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Sager Patel
- The University of Utah Transplant and Cellular Therapy Program, Salt Lake City, Utah
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Scott Solomon
- Northside Hospital Cancer Institute, Atlanta, Georgia
| | - Daniel R Couriel
- The University of Utah Transplant and Cellular Therapy Program, Salt Lake City, Utah
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31
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Tao R, Chen Y, Kim S, Ocier K, Lloyd S, Poppe MM, Lee CJ, Glenn MJ, Smith KR, Fraser A, Deshmukh V, Newman MG, Snyder J, Rowe KG, Gaffney DK, Haaland B, Hashibe M. Mental health disorders are more common in patients with Hodgkin lymphoma and may negatively impact overall survival. Cancer 2022; 128:3564-3572. [PMID: 35916651 DOI: 10.1002/cncr.34359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/19/2022] [Accepted: 05/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Long-term mental health outcomes were characterized in patients who were diagnosed with Hodgkin lymphoma (HL), and risk factors for the development of mental health disorders were identified. METHODS Patients who were diagnosed with HL between 1997 and 2014 were identified in the Utah Cancer Registry. Each patient was matched with up to five individuals from a general population cohort identified within the Utah Population Database, a unique source of linked records that includes patient and demographic data. RESULTS In total, 795 patients who had HL were matched with 3575 individuals from the general population. Compared with the general population, patients who had HL had a higher risk of any mental health diagnosis (hazard ratio, 1.77; 95% confidence interval, 1.57-2.00). Patients with HL had higher risks of anxiety, depression, substance-related disorders, and suicide and intentional self-inflicted injuries compared with the general population. The main risk factor associated with an increased risk of being diagnosed with mental health disorders was undergoing hematopoietic stem cell transplantation, with a hazard ratio of 2.06 (95% confidence interval, 1.53-2.76). The diagnosis of any mental health disorder among patients with HL was associated with a detrimental impact on overall survival; the 10-year overall survival rate was 70% in patients who had a mental health diagnosis compared with 86% in those patients without a mental health diagnosis (p < .0001). CONCLUSIONS Patients who had HL had an increased risk of various mental health disorders compared with a matched general population. The current data illustrate the importance of attention to mental health in HL survivorship, particularly for patients who undergo therapy with hematopoietic stem cell transplantation.
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Affiliation(s)
- Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Yuji Chen
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Seungmin Kim
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Krista Ocier
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Matthew M Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Catherine J Lee
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Martha J Glenn
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Ken R Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - Michael G Newman
- University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Kerry G Rowe
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Ben Haaland
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
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Himbert C, Hathaway CA, Daniels B, Salas K, Ashworth A, Gigic B, Lin T, Viskochil R, Kirchhoff AC, Grossman D, Ose J, Tward J, Scaife C, Figueiredo JC, Toriola AT, Beck A, Shibata D, Gonzalez BD, Matsen C, Christenson C, Ma DS, Colman H, Hunt JP, Jones KB, Lee CJ, Larson M, Onega T, Akerley WL, Li CI, Schneider M, Penedo FJ, Siegel EM, Tworoger SS, Ulrich CM, Peoples AR. Factors associated with changes in exercise behaviors during the COVID-19 pandemic. Cancer Causes Control 2022; 33:939-950. [PMID: 35554777 PMCID: PMC9096745 DOI: 10.1007/s10552-022-01580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/28/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE There is limited information on how the COVID-19 pandemic has changed health behaviors among cancer patients. We examined changes in exercise behaviors since the pandemic and identified characteristics associated with these changes among cancer patients. METHODS Cancer patients (n = 1,210) completed a survey from August to September 2020 to assess COVID-19 pandemic-related changes in health behaviors and psychosocial factors. Patients were categorized into three groups: exercising less, exercising did not change, and exercising more. Patient characteristics were compared by exercise groups. RESULTS One-third of the patients reported a decreased amount of regular exercise, while 10% reported exercising more during the pandemic. Patients who exercised less were more likely to be unemployed/retired and have poor health status and psychosocial stressors such as disruptions in daily life while less likely to be former smokers (all p < 0.05). In contrast, patients who exercised more were younger, had stage IV diagnosis, and also reported disruptions in daily life (all p < 0.05). Patients who were living in rural areas were also more likely not to experience changes in exercise habits (all p < 0.05), although rural-urban status was not identified as a strong predictor. CONCLUSION A significant proportion of cancer patients experienced changes in exercise habits, especially exercising less, during the first 6 months of the COVID-19 pandemic. Age, employment status, tumor stage, health status, smoking status, and psychosocial factors were associated with changes in exercise behaviors. Our results highlight the importance of promoting physical activity guidelines for cancer survivorship during the COVID-19 pandemic and may help improve the identification of cancer patients susceptible to exercising less.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Cassandra A Hathaway
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Karen Salas
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Biljana Gigic
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Anne C Kirchhoff
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jonathan Tward
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Courtney Scaife
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jane C Figueiredo
- Department of Medicine, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Adetunji T Toriola
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - David Shibata
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Cindy Matsen
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Debra S Ma
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Howard Colman
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Jason P Hunt
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kevin B Jones
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Catherine J Lee
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Tracy Onega
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Wallace L Akerley
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Martin Schneider
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, USA
| | - Erin M Siegel
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Anita R Peoples
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
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Peoples AR, Oswald LB, Ose J, Daniels B, Himbert C, Hathaway CA, Gigic B, Kirchhoff AC, Lin T, Grossman D, Tward J, Varghese TK, Figueiredo JC, Toriola AT, Beck A, Scaife C, Shibata D, LaStayo P, Gonzalez B, Salas K, Ashworth A, Matsen C, Christenson C, Ma DS, Colman H, Hunt JP, Jones KB, Lee CJ, Larson M, Onega T, Akerley WL, Li CI, Schneider M, Penedo FJ, Siegel EM, Tworoger SS, Ulrich CM. Impact of the COVID-19 pandemic on rural and urban cancer patients' experiences, health behaviors, and perceptions. J Rural Health 2022; 38:886-899. [PMID: 35243690 PMCID: PMC9115146 DOI: 10.1111/jrh.12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose The COVID‐19 pandemic has disrupted many facets of life. We evaluated pandemic‐related health care experiences, COVID‐19 prevention behaviors and measures, health behaviors, and psychosocial outcomes among rural and urban cancer patients. Methods Among 1,472 adult cancer patients, who visited Huntsman Cancer Institute in the past 4 years and completed a COVID‐19 survey (August‐September 2020), we assessed the impact of the pandemic on medical appointments, prevention/health behaviors, and psychosocial factors, stratified by urbanicity. Findings Mean age was 61 years, with 52% female, 97% non‐Hispanic White, and 27% were residing in rural areas. Rural versus urban patients were more likely to be older, not employed, uninsured, former/current smokers, consume alcohol, and have pandemic‐related changes/cancellations in surgery appointments (all P<.05). Changes/cancellations in other health care access (eg, doctor's visits) were also common, particularly among urban patients. Urban versus rural patients were more likely to socially distance, use masks and hand sanitizer, and experience changes in exercise habits and in their daily lives (all P<.05). Less social interaction and financial stress were common among cancer patients but did not differ by urbanicity. Conclusions These findings suggest that the COVID‐19 pandemic had a substantial impact on cancer patients, with several challenges specific to rural patients. This comprehensive study provides unique insights into the first 6 months of COVID‐19 pandemic‐related experiences and continuity of care among rural and urban cancer patients predominantly from Utah. Further research is needed to better characterize the pandemic's short‐ and long‐term effects on rural and urban cancer patients and appropriate interventions.
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Affiliation(s)
- Anita R Peoples
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Laura B Oswald
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Cassandra A Hathaway
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Anne C Kirchhoff
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan Tward
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Thomas K Varghese
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Adetunji T Toriola
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Courtney Scaife
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - David Shibata
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paul LaStayo
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Brian Gonzalez
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Karen Salas
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Cindy Matsen
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | - Debra S Ma
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Howard Colman
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jason P Hunt
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kevin B Jones
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA
| | - Catherine J Lee
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Tracy Onega
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Wallace L Akerley
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA.,Departments of Psychology and Medicine, University of Miami, Coral Gables, Florida, USA
| | - Erin M Siegel
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Muffly L, Lee CJ, Gandhi A, Varma A, Scott BL, Kwon HS, Yanagiba C, Arulprakasam J, Reddy M, Heller KN, Shizuru JA, Pang WW, Artz A. Preliminary Data from a Phase 1 Study of JSP191, an Anti-CD117 Monoclonal Antibody, in Combination with Low Dose Irradiation and Fludarabine Conditioning Is Well-Tolerated, Facilitates Chimerism and Clearance of Minimal Residual Disease in Older Adults with MDS/AML Undergoing Allogeneic HCT. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Byrne M, Kurian T, Patel D, Tamari R, Hong S, Abdelhakim H, Klein V, Rojas P, Madhavan R, Kent A, Logan AC, Lee CJ, Husnain M, Manning B, Tschernia N, Dias A, Margalski D, Goldenson B, Byrne ND, Chen H, Petrova-Drus K, Sengsayadeth S, Goodman A, Howard DS, Wood WA, Gill S, Jimenez AJ, Gutman JA, Gowda L, Metheny III L, Bhatnagar B, Hamilton BK, Mishra A, Savona MR. A Multi-Center Collaborative Study of Outcomes of TP53-Mutated MDS/AML Patients Following Allogeneic HCT. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Rotz SJ, Hamilton BK, Koo J, Nawabit R, Ferraro CS, Lalefar N, Stafford LA, Barbosa Mariano LC, Ahmed-Winston S, Phelan R, Ngwube A, Lee CJ, Whiteside S, Gloude NJ, Myers KC. Assessment of Fertility Potential and Gonadal Function in Survivors of Reduced Intensity Hematopoetic Cell Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Fennell K, Keller MA, Villa MA, Paccapelo C, Kucerakova M, Rosochova J, Clemente DosSantos C, Brackney L, Lee CJ, Metcalf R, Crovetti G, Barbieri M, Travali S, Barrotta G, Giuca G, Guerra LE, Ochoa-Garay G. New ABO intron 1 variant alleles. Immunohematology 2021; 37:178-184. [PMID: 34964317 DOI: 10.21307/immunohematology-2021-029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Unusual and discrepant ABO phenotypes are often due to genetic variants that lead to altered levels or activity of ABO transferases and consequently to altered expression of ABO antigens. This report describes eight genetic alterations found in 15 cases with reduced or undetectable expression of ABO antigens. Forward and reverse ABO grouping was performed by standard gel or tube methods. Adsorption-heat elution and saliva testing for H and A substances followed the AABB technical manual procedures. Genomic DNA extracted from whole blood was PCR-amplified to cover the entire ABO coding sequence, splice junctions, proximal promoter, and intron 1 enhancer. Amplification products were sequenced by next-generation or Sanger dideoxy methods, either directly or after cloning into a bacterial plasmid vector. Eight unreported alleles were found in the 15 cases analyzed. Alleles ABO*A(28+1C) and ABO*A(29-5G) harbor variants that alter the consensus sequence at the intron 1 donor and acceptor splice sites, respectively. The other alleles harbor variants that alter the consensus sequence at transcription factor-binding sites in the intron 1 enhancer: specifically, ABO*A(28+5792T), ABO*A(28+5859A), and ABO*A(28+5860G) at GATA-1 sites; ABO*B(28+5877T) and ABO*B(28+5878G) at a RUNX1 site; and ABO*A(28+5843A) at or near a C/EBP site. Molecular and serologic characterization of ABO alleles can help in their future identification and in the resolution of discrepancies. Unusual and discrepant ABO phenotypes are often due to genetic variants that lead to altered levels or activity of ABO transferases and consequently to altered expression of ABO antigens. This report describes eight genetic alterations found in 15 cases with reduced or undetectable expression of ABO antigens. Forward and reverse ABO grouping was performed by standard gel or tube methods. Adsorption-heat elution and saliva testing for H and A substances followed the AABB technical manual procedures. Genomic DNA extracted from whole blood was PCR-amplified to cover the entire ABO coding sequence, splice junctions, proximal promoter, and intron 1 enhancer. Amplification products were sequenced by next-generation or Sanger dideoxy methods, either directly or after cloning into a bacterial plasmid vector. Eight unreported alleles were found in the 15 cases analyzed. Alleles ABO*A(28+1C) and ABO*A(29–5G) harbor variants that alter the consensus sequence at the intron 1 donor and acceptor splice sites, respectively. The other alleles harbor variants that alter the consensus sequence at transcription factor–binding sites in the intron 1 enhancer: specifically, ABO*A(28+5792T), ABO*A(28+5859A), and ABO*A(28+5860G) at GATA-1 sites; ABO*B(28+5877T) and ABO*B(28+5878G) at a RUNX1 site; and ABO*A(28+5843A) at or near a C/EBP site. Molecular and serologic characterization of ABO alleles can help in their future identification and in the resolution of discrepancies.
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Affiliation(s)
- K Fennell
- Laboratory Manager, Thermo Fisher Scientific , Austin, TX
| | - M A Keller
- Executive at American Red Cross Biomedical Services , Philadelphia, PA
| | - M A Villa
- Retired from Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico , Milan , Italy
| | - C Paccapelo
- Cinzia Paccapelo, SDc Biology, Senior Assistant in Immunohematology, Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico , Milan , Italy
| | - M Kucerakova
- Head, Department of Hematology and Blood Bank Narodna Transfuzna Sluzba SR , Bratislava , Slovakia
| | - J Rosochova
- Specialist in Transfusion Medicine, Narodna Transfuzna Sluzba SR , Bratislava , Slovakia
| | | | - L Brackney
- Medical Director of Blood Bank, Elmhurst Memorial Hospital , Elmhurst, IL
| | - C J Lee
- Assistant Professor of Internal Medicine, University of Utah Health , Salt Lake City , UT
| | - R Metcalf
- Medical Director of Transfusion Service, University of Utah Health , Salt Lake City, UT
| | - G Crovetti
- Medical Director, Immunoematologia e Centro Trasfusionale , ASST Valle Olona , Italy
| | - M Barbieri
- Lab Technician, Immunoematologia e Centro Trasfusionale , ASST Valle Olona , Italy
| | - S Travali
- Biologist, Laboratory Director, Servizio di Immunoematologia e Medicina Trasfusionale , Ragusa , Italy
| | - G Barrotta
- Biologist, Executive Biologist, Servizio di Immunoematologia e Medicina Trasfusionale , Ragusa , Italy
| | - G Giuca
- Biologist, Executive Biologist, Servizio di Immunoematologia e Medicina Trasfusionale , Ragusa , Italy
| | - L E Guerra
- Immunohematologist, Independent Consultant , Wimberly , TX
| | - G Ochoa-Garay
- New York Blood Center , 45-01 Vernon Boulevard, Long Island City , NY 11101
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Ocier K, Abdelaziz S, Kim S, Rowe K, Snyder J, Deshmukh VG, Newman M, Fraser A, Smith KR, Porucznik CA, Shoaf K, Stanford JB, Lee CJ, Hashibe M. Age-Related Disease Risks in Younger versus Older B-Cell Non-Hodgkin's Lymphoma Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:2268-2277. [PMID: 34732401 PMCID: PMC9894530 DOI: 10.1158/1055-9965.epi-21-0190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/05/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Younger cancer survivors may develop age-related diseases due to the cancer treatment that they undergo. The aim of this population-based study is to estimate incidence of age-related diseases besides cardiovascular disease among younger versus older B-cell non-Hodgkin's lymphoma (B-NHL) survivors compared with their respective general population cohorts. METHODS Survivors of B-NHL were diagnosed between 1997 and 2015 from the Utah Cancer Registry. Using the Utah Population Database, up to 5 cancer-free individuals from the general population were matched with a B-NHL survivor on sex, birth year, and state of birth. Hazard ratios (HR) for age-related disease outcomes, which were identified from medical records and statewide health care facility data, were estimated using Cox Proportional Hazards models for B-NHL survivors diagnosed at <65 years versus ≥65 years at least 5 years since B-NHL diagnosis. RESULTS Comparing 2,129 B-NHL survivors with 8,969 individuals from the general population, younger B-NHL survivors had higher relative risks of acute renal failure [HR, 2.24; 99% confidence interval (CI), 1.48-3.39; P heterogeneity = 0.017), pneumonia (HR, 2.42; 99% CI, 1.68-3.49; P heterogeneity = 0.055), and nutritional deficiencies (HR, 2.08; 99% CI, 1.48-2.92; P heterogeneity = 0.051) ≥5 years after cancer diagnosis. CONCLUSION Younger B-NHL survivors had higher relative risks of acute renal failure, pneumonia, and nutritional deficiencies than older B-NHL survivors compared with their respective general population cohorts, ≥5 years after cancer diagnosis.
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Affiliation(s)
- Krista Ocier
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Seungmin Kim
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken R Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kimberley Shoaf
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joseph B Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Catherine J Lee
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
- Huntsman Cancer Institute, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
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39
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Woo J, Kim JE, Im JJ, Lee J, Jeong HS, Park S, Jung SY, An H, Yoon S, Lim SM, Lee S, Ma J, Shin EY, Han YE, Kim B, Lee EH, Feng L, Chun H, Yoon BE, Kang I, Dager SR, Lyoo IK, Lee CJ. Correction: Astrocytic water channel aquaporin-4 modulates brain plasticity in both mice and humans: a potential gliogenetic mechanism underlying language-associated learning. Mol Psychiatry 2021; 26:7853. [PMID: 34305137 DOI: 10.1038/s41380-021-01185-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J Woo
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,Neuroscience Program, University of Science and Technology (UST), Daejeon, Republic of Korea
| | - J E Kim
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, Republic of Korea.,Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea
| | - J J Im
- Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea.,Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - J Lee
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,Division of Functional Food Research, Korea Food Research Institute, Seongnam, Republic of Korea
| | - H S Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S Park
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - S- Y Jung
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,Neuroscience Program, University of Science and Technology (UST), Daejeon, Republic of Korea
| | - H An
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,KU-KIST Graduate School of Converging Science and Technology, Korea University,145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea
| | - S M Lim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - S Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea.,Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - J Ma
- Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea.,Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - E Y Shin
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, Republic of Korea.,Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea
| | - Y- E Han
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,Neuroscience Program, University of Science and Technology (UST), Daejeon, Republic of Korea
| | - B Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea.,Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - E H Lee
- Green Cross Laboratories, Yongin, Republic of Korea
| | - L Feng
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - H Chun
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - B- E Yoon
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,Department of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - I Kang
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, Republic of Korea.,Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea
| | - S R Dager
- Department of Radiology, University of Washington, Seattle, WA, USA.,Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - I K Lyoo
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, Republic of Korea. .,Ewha Brain Institute, Ewha Womans University, Seoul, Republic of Korea. .,Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea.
| | - C J Lee
- Center for Neural Science and Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea. .,Neuroscience Program, University of Science and Technology (UST), Daejeon, Republic of Korea. .,KU-KIST Graduate School of Converging Science and Technology, Korea University,145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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40
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Jiang D, Kuchta K, Amundson J, Tafur A, Morcos O, Lind B, Qamar A, Lee CJ. Increasing prevalence of diabetic peripheral angiopathy and complications in hospitalized patients in the United States. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
We aim to assess prevalence of diabetes related peripheral arterial disease and associated outcomes in hospitalized patients in the United States.
Methods
Trends in hospitalizations in diabetic patients with PAD were determined using the 2003–2017 National Inpatient Sample database. Hospital outcomes including diabetic ulcer incidence, amputations, and revascularizations were analyzed.
Results
The analysis included 10,303,673 hospitalizations in diabetic patients with PAD (DMPAD) during the study period. Prevalence of PAD among patients with diabetes increased over time (p<0.001). The prevalence of foot ulcers in diabetics have also increased over time (p<0.001). The incidence of amputations in patients with diabetes showed a decreasing trend with increasing prevalence of revascularizations from 2003 to 2009. Since 2010 however, rising rates of amputations, both minor and major are seen, especially in younger populations (age 18–49). Hospital costs for amputations have increased ($6.6 billion in 2003 vs $ 14.8 billion in 2017) as well as the costs for revascularization (6.1 billion in 2003 vs $13 billion in 2017) during the study period (p<0.001).
Conclusions
In this analysis of patients with DMPAD, an alarming rate of disease prevalence and in-hospital limb outcomes, including costs, are realized in the current era.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Jiang
- The University of Chicago, Surgery, Chicago, United States of America
| | - K Kuchta
- NorthShore University Health System, Surgery, Chicago, United States of America
| | - J Amundson
- The University of Chicago, Surgery, Chicago, United States of America
| | - A Tafur
- NorthShore University Health System, Cardiology, Chicago, United States of America
| | - O Morcos
- NorthShore University Health System, Surgery, Chicago, United States of America
| | - B Lind
- NorthShore University Health System, Surgery, Chicago, United States of America
| | - A Qamar
- NorthShore University Health System, Cardiology, Chicago, United States of America
| | - C J Lee
- NorthShore University Health System, Surgery, Chicago, United States of America
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41
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Himbert C, Hathaway CA, Daniels B, Salas K, Ashworth A, Gigic B, Lin T, Viskochil R, Kirchhoff AC, Grossman D, Ose J, Tward J, Scaife C, Figueiredo JC, Toriola AT, Beck A, Shibata D, Gonzalez BD, Matsen C, Christenson C, Ma DS, Colman H, Hunt JP, Jones KB, Lee CJ, Larson M, Onega T, Akerley WL, Li CI, Schneider M, Penedo FJ, Siegel EM, Tworoger SS, Ulrich CM, Peoples AR. Impact of the COVID-19 pandemic on exercise habits among cancer patients. Res Sq 2021:rs.3.rs-704646. [PMID: 34580667 PMCID: PMC8475966 DOI: 10.21203/rs.3.rs-704646/v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose There is limited information on how the COVID-19 pandemic has changed health behaviors among cancer patients. We examined the impact of the pandemic on changes in exercise behaviors and identified characteristics associated with these changes among cancer patients. Methods Cancer patients (n = 1,361) completed a survey from August-September 2020 to assess COVID-19 pandemic-related changes in health behaviors and psychosocial factors. Patients were categorized into 3 groups: exercising less, exercising did not change, and exercising more. Patient characteristics were compared by exercise groups. Results One-third of the patients reported a decreased amount of regular exercise, while 11% reported exercising more during the pandemic. Patients who exercised less were more likely to be unemployed/retired, undergoing active treatment, and had increased pandemic-related alcohol consumption and psychosocial stressors such as loneliness and financial stress (all p < 0.05). In contrast, patients who exercised more were younger, female, full-time employed, did not consume alcohol, and had good health status and more social interactions (all p < 0.05). Patients who were living in rural areas and did not experience changes in daily life, were also more likely not to experience changes in exercise habits (all p < 0.05). Conclusion Our results indicate that a significant proportion of cancer patients experienced changes in exercise habits during the first 6 months of the COVID-19 pandemic. Age, sex, employment status, health status, alcohol consumption, and psychosocial factors were associated with changes in exercise behaviors. Providers should monitor for changes in health behaviors, such as exercise, because of their importance in improving cancer survivorship.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | | | - Bailee Daniels
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Karen Salas
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Anjelica Ashworth
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Biljana Gigic
- Heidelberg University: Ruprecht Karls Universitat Heidelberg
| | - Tengda Lin
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Richard Viskochil
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Anne C Kirchhoff
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Douglas Grossman
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Jennifer Ose
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Jonathan Tward
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Courtney Scaife
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Jane C Figueiredo
- Cedars-Sinai Comprehensive Cancer Center: Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute
| | | | - Anna Beck
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - David Shibata
- University of Tennessee Health Science Center Bookstore: The University of Tennessee Health Science Center VolShop Memphis
| | | | - Cindy Matsen
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Cristina Christenson
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Debra S Ma
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Howard Colman
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Jason P Hunt
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Kevin B Jones
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Catherine J Lee
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Mikaela Larson
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Tracy Onega
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | - Wallace L Akerley
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
| | | | | | | | | | | | | | - Anita R Peoples
- Huntsman Cancer Institute Cancer Hospital: University of Utah Health Huntsman Cancer Institute
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42
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Lee CJ, Pusic I, Savani BN. Beyond ruxolitinib in steroid-refractory acute graft-versus-host disease. Br J Haematol 2021; 195:306-307. [PMID: 34402041 DOI: 10.1111/bjh.17735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Catherine J Lee
- Utah Transplantation & Cellular Therapy Program, Huntsman Cancer Institute at University of Utah, Salt Lake City, UT, USA
| | - Iskra Pusic
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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43
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Radojcic V, Pletneva M, Lee CJ, Ivcevic S, Sarantopoulos S, Couriel D. Hedgehog blockade in steroid-refractory sclerotic chronic graft-versus-host disease. Br J Haematol 2021; 195:e120-e122. [PMID: 34142367 DOI: 10.1111/bjh.17657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vedran Radojcic
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Maria Pletneva
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Catherine J Lee
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Sanja Ivcevic
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, England
| | - Daniel Couriel
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Ocier K, Abdelaziz S, Kim S, Rowe K, Snyder J, Deshmukh V, Newman M, Fraser A, Smith K, Porucznik CA, Shoaf K, Stanford JB, Lee CJ, Hashibe M. Cardiovascular disease risks in younger versus older adult B-cell non-Hodgkin's lymphoma survivors. Cancer Med 2021; 10:4117-4126. [PMID: 33979029 PMCID: PMC8209610 DOI: 10.1002/cam4.3934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/24/2021] [Accepted: 04/03/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Young cancer survivors may be at increased risk of early‐onset chronic health conditions. The aim of this population‐based study is to estimate cardiovascular disease (CVD) risk among younger versus older B‐cell non‐Hodgkin's lymphoma (B‐NHL) survivors compared with their respective general population cohorts. Methods B‐NHL survivors diagnosed from 1997 to 2015 in the Utah Cancer Registry were matched with up to five cancer‐free individuals on birth year, sex, and birth state, using the statewide Utah Population Database. Electronic medical records and statewide health care facility data were used to identify disease outcomes ≥5 years after cancer diagnosis. Cox Proportional Hazards models were used to estimate hazard ratios for B‐NHL survivors diagnosed at <65 years and ≥65 years old. Results Younger B‐NHL survivors had higher relative risks than older cancer survivors of chronic rheumatic disease of the heart valves (HR = 4.14, 99% CI = 2.17–7.89; P valueheterogeneity = 0.004); peri‐, endo‐, and myocarditis (HR = 2.43, 99% CI = 1.38–4.28; P valueheterogeneity = 0.016); diseases of the arteries (HR = 1.63, 99% CI = 1.21–2.21; P valueheterogeneity = 0.044); and hypotension (HR = 2.44, 99% CI = 1.58–3.75; P valueheterogeneity = 0.048). B‐NHL survivors of both age groups had elevated relative risks of heart disease overall and congestive heart failure. Conclusion Younger B‐NHL survivors had higher risks than older B‐NHL survivors of specific cardiovascular diseases compared to their respective general population cohorts.
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Affiliation(s)
- Krista Ocier
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Seungmin Kim
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Christina A Porucznik
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kimberley Shoaf
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph B Stanford
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Catherine J Lee
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA.,Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
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Lee CJ, Wang T, Chen K, Spellman SR, Kitko CL, MacMillan ML, Pidala JA, Auletta JJ, Badawy S, Battiwalla M, Bhatt VR, Buchbinder D, Cahn JY, DeFilipp Z, Diaz MA, Farhadfar N, Gadalla SM, Gale RP, Hashem H, Hashmi SK, Hematti P, Hong S, Hossain N, Inamoto Y, Kamble RT, Kumar A, Lekakis LJ, Modi D, Patel S, Savani B, Sharma A, Solomon SR, Verdonck L, Arora M, Couriel DR. First Late Effect in Pediatric Survivors with Chronic Graft-Versus-Host Disease Following Hematopoietic Cell Transplantation for Hematologic Malignancy. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Martin R, Kim M, Lee CJ, Mehar V, Albertin S, Hejral U, Merte LR, Lundgren E, Asthagiri A, Weaver JF. High-Resolution X-ray Photoelectron Spectroscopy of an IrO 2(110) Film on Ir(100). J Phys Chem Lett 2020; 11:7184-7189. [PMID: 32787312 DOI: 10.1021/acs.jpclett.0c01805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
High-resolution X-ray photoelectron spectroscopy (XPS) and density functional theory (DFT) were used to characterize IrO2(110) films on Ir(100) with stoichiometric as well as OH-rich terminations. Core-level Ir 4f and O 1s peaks were identified for the undercoordinated Ir and O atoms and bridging and on-top OH groups at the IrO2(110) surfaces. Peak assignments were validated by comparison of the core-level shifts determined experimentally with those computed using DFT, quantitative analysis of the concentrations of surface species, and the measured variation of the Ir 4f peak intensities with photoelectron kinetic energy. We show that exposure of the IrO2(110) surface to O2 near room temperature produces a large quantity of on-top OH groups because of reaction of background H2 with the surface. The peak assignments made in this study can serve as a foundation for future experiments designed to utilize XPS to uncover atomic-level details of the surface chemistry of IrO2(110).
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Affiliation(s)
- R Martin
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
| | - M Kim
- William G. Lowrie Chemical & Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - C J Lee
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
| | - V Mehar
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
| | - S Albertin
- Division of Synchrotron Radiation Research, Lund University, SE-22100 Lund, Sweden
| | - U Hejral
- Division of Synchrotron Radiation Research, Lund University, SE-22100 Lund, Sweden
| | - L R Merte
- Materials Science and Applied Mathematics, Malmö University, SE-205 06 Malmö, Sweden
| | - E Lundgren
- Division of Synchrotron Radiation Research, Lund University, SE-22100 Lund, Sweden
| | - A Asthagiri
- William G. Lowrie Chemical & Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - J F Weaver
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
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47
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Barnes CA, Stout NL, Varghese, Jr TK, Ulrich CM, Couriel DR, Lee CJ, Noren CS, LaStayo PC. Clinically Integrated Physical Therapist Practice in Cancer Care: A New Comprehensive Approach. Phys Ther 2020; 100:543-553. [PMID: 32043139 PMCID: PMC8204882 DOI: 10.1093/ptj/pzz169] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/29/2023]
Abstract
Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient's level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure-the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual-and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators.
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Affiliation(s)
- Christopher A Barnes
- Department of Physical Therapy and Athletic Training, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Nicole L Stout
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Bethesda, Maryland
- Department of Hematology Oncology, Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Thomas K Varghese, Jr
- Huntsman Cancer Institute, and School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, and Department of Population Health Sciences, University of Utah
| | - Daniel R Couriel
- Huntsman Cancer Institute, and School of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah
| | - Catherine J Lee
- Huntsman Cancer Institute, and School of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah
| | | | - Paul C LaStayo
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108 (USA), and Huntsman Cancer Institute, University of Utah
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48
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Abstract
We investigated adsorption of N2 on stoichiometric and O-rich IrO2(110) surfaces using temperature programmed desorption (TPD) experiments and density functional theory (DFT) calculations. TPD shows that N2 desorbs predominantly from the stoichiometric-IrO2(110) surface in a well-defined peak at 270 K for N2 coverages below about 0.5 ML and that a shoulder centered near 235 K develops in the N2 TPD traces as the coverage approaches saturation, indicating that adsorbed N2 molecules destabilize at high N2 coverages. Experiments of N2 adsorption onto O-rich IrO2(110) surfaces provide evidence that N2 adsorbs exclusively on the coordinatively unsaturated Ir atoms (Ircus) of the surface and that pre-adsorbed O-atoms ("on-top" oxygen) stabilize adsorbed N2 molecules, causing the main N2 TPD peak to shift toward higher temperature with increasing oxygen coverages. Consistent with prior results, our DFT calculations predict that an N2 molecule preferentially adsorbs into an upright configuration on an Ircus atom of the IrO2(110) surface and achieves a binding energy of about 100 kJ/mol. The computed binding energy agrees well with our experimental estimate of ∼90 kJ/mol for low N2 coverages on stoichiometric IrO2(110). The DFT calculations also quantitatively reproduce the observed stabilization of N2 by co-adsorption on-top O-atoms and predict the destabilization of N2 on IrO2(110) as the N2 adlayer becomes crowded at high coverages.
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Affiliation(s)
- R Martin
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, USA
| | - M Kim
- William G. Lowrie Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, USA
| | - C J Lee
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, USA
| | - M S Shariff
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, USA
| | - F Feng
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, USA
| | - R J Meyer
- ExxonMobil Research and Engineering, Annandale, New Jersey 08801, USA
| | - A Asthagiri
- William G. Lowrie Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, USA
| | - J F Weaver
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, USA
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49
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Affiliation(s)
- James D. Osborn
- Utah Blood and Marrow Transplantation Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Paloma F. Cariello
- Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT, USA
| | - Esteban Pena
- Utah Blood and Marrow Transplantation Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Catherine J. Lee
- Utah Blood and Marrow Transplantation Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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50
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Lee CJ, Hwang J, Kang CY, Kim H, Ha J, Chun KH, Oh J, Lee S, Kang SM, Park S, Yoo TH. P5731Optimal blood pressure in diabetic hypertensive patients with overt proteinuria. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence for the benefit of intensive blood pressure lowering in diabetic nephropathy is not clear at this time. The objective of this study was to demonstrate whether lower mean blood pressure (BP) in treated hypertensive patients with diabetic nephropathy is associated with better prognosis.
Methods
From the National Health Insurance Service (NHIS) Health Examination Database, diabetic hypertensive subjects with proteinuria between 2009 and 2010 were selected and followed-up until 2015 (N=8,663). Mean of the recorded systolic and diastolic BP during follow-up health examinations were stratified into five categories (SBP: <120, 120 to <130, 130 to <140, 140 to <150, and ≥150 mmHg; DBP: <70, 70 to <80, 80 to <90, 90 to <100, and ≥100 mmHg). All-cause death, myocardial infarction (MI), stroke, and renal outcome (progression to end stage renal disease or doubling of serum creatinine) were examined by Cox proportional hazard models with the propensity scores adjusted method.
Results
Compared to SBP of 130 to <140 mmHg, SBP of 120 to <130 mmHg was associated with lower risk of all-cause death (HR=0.78; 95% CI, 0.64–0.95), stroke (HR: 0.65; 95% CI, 0.45–0.94), and renal outcome (HR: 0.81; 95% CI, 0.68–0.97). SBP of <120 mmHg was associated with benefit for renal outcomes (HR: 0.69; 95% CI 0.55–0.88) but not with elevated risk of other outcomes. Compared to DBP of 80 to <90 mmHg, DBP of 70 to <80 mmHg were associated with lower risk of all-cause death (HR: 0.75; 95% CI, 0.64–0.88) but with higher risk of MI (HR: 1.52; 95% CI, 1.05–2.21). DBP of <70 mmHg was associated with reduced risk of all-cause death (HR: 0.79; 95% CI, 0.64–0.98).
Conclusion
In diabetic hypertensive subjects with overt proteinuria, deterioration of renal function decreased with decreasing SBP and the lowest risk of all-cause death and stroke were observed in SBP <130 mmHg. Low DBP was associated with low risk of all-cause death but there was a J curve phenomenon for MI in DBP of 70 to <80 mmHg.
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Affiliation(s)
- C J Lee
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Hwang
- Daegu University, Department of Statistics and Computer Science, Gyeongbuk, Korea (Republic of)
| | - C Y Kang
- Daegu University, Department of Statistics and Computer Science, Gyeongbuk, Korea (Republic of)
| | - H Kim
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Ha
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - K.-H Chun
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Oh
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - S.H.- Lee
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - S.-M Kang
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - S Park
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - T.-H Yoo
- Yonsei University College of Medicine, Division of Nephrology, Department of Internal Medicine, Seoul, Korea (Republic of)
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